The U.S. 6th Circuit Court recently upheld a DHHS Departmental Appeals Board decision that found a skilled nursing facility’s (“SNF”) deficiencies were at an “immediate jeopardy” level relating to a failure to notify a physician or family member of a significant change in a patient’s condition. See, Claiborne-Hughes Health Center v. Sebelius, 6th Cir. No 09-3239, 6/25/10. Continue reading
Category Archives: Civil Litigation
OIG Enters into $7.3 Million Settlement and Corporate Integrity Agreement with Lithotripsy Physicians and Related Entities
On July 8, 2010, the OIG released a press release announcing that it entered into a 7.3 million dollar civil monetary penalty (“CMP”) settlement agreement with United Shockwave Services, United Prostate Centers, and United Urology Centers (the “Settlement Parties”), all based in the Chicago, Illinois area. The agreement settles charges that, by soliciting and receiving payments from hospitals in exchange for patient referrals, the Settlement Parties violated Federal anti-kickback laws. Continue reading
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Posted in Acute Care, Anti-Kackback, Civil Litigation, Corporate Integrity Agreements, Fraud and Abuse, Hospital, Illinois, Medicare, OIG, Out-Patient Care, Physicians, Self-Referral, Settlements
OIG Enters into $7.3 Million Settlement and Corporate Integrity Agreement with Lithotripsy Physicians and Related Entities
On July 8, 2010, the OIG released a press release announcing that it entered into a 7.3 million dollar civil monetary penalty (“CMP”) settlement agreement with United Shockwave Services, United Prostate Centers, and United Urology Centers (the “Settlement Parties”), all based in the Chicago, Illinois area. The agreement settles charges that, by soliciting and receiving payments from hospitals in exchange for patient referrals, the Settlement Parties violated Federal anti-kickback laws. The OIG alleged that the Settlement Parties and certain of its physician-owners, leveraged patient referrals to obtain contract business from hospitals in Illinois, Indiana, and Iowa. OIG also alleged that Settlement Parties caused certain hospitals to submit claims for designated health services that resulted from prohibited referrals in violation of the Physician Self-Referral Law (the “Stark law”).
Under the 5-year Corporate Integrity Agreement, the Settlement Parties are required to hire an Independent Review Organization. The independent reviewer will monitor lithotripsy and laser arrangements between them and any hospital in Illinois, Iowa, and Indiana that receives referrals from them or their physician investors. The Settlement Parties are also required to create a comprehensive training program to educate employees and corporate members on Stark law and kickback issues.
In resolving the matter through a settlement agreement, the Settlement Parties have denied any liability.
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Posted in Acute Care, Civil Litigation, Fraud and Abuse, Health Care, Health Care Providers, Hospital, Illinois, Iowa, OIG, Out-Patient Care, Physicians, Self-Referral
Tagged Anti-kickback, CIA, CMS, Designated Health Services, Lithotripsy, Medicaid, Medicare, OIG, Physician, Practitioner, Self-Referral, Settlement, Stark
Circuit Court Upholds Immediate Jeopardy for Failure to Notify of Significant Change in Patient’s Condition
The U.S. 6th Circuit Court recently upheld a DHHS Departmental Appeals Board decision that found a skilled nursing facility’s (“SNF”) deficiencies were at an “immediate jeopardy” level relating to a failure to notify a physician or family member of a significant change in a patient’s condition. See, Claiborne-Hughes Health Center v. Sebelius, 6th Cir. No 09-3239, 6/25/10.
The Claiborne-Hughes Health Center is a SNF in Franklin, TN. The decision was based upon surveyors findings that the facility failed to comply with 42 C.F.R. §483.10(b)(11). Section 483.10(b)(11) requires a facility to immediately consult with a resident’s physician and notify the resident’s family members or legal representation when there is a significant change in a resident’s physical, mental, or psychosocial status.
The failure to comply with the applicable regulation related to Claiborne-Hughes’ policy on recording patient fluid-intake. Surveys completed in August and September of 2006 revealed that the facility was not sufficiently monitoring patient fluid intake in accordance with its own policies.
A copy of the decision can be found at – http://caselaw.findlaw.com/us-6th-circuit/1529702.html
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Posted in Civil Litigation, DAB Decisions, Health Care, Health Care Providers, Nursing Home, Participation, Post Acute Care, Tennessee
Tagged ALJ Decisions, Certification, CMS, Conditions of Participation, Departmental Appeals Board, Immediate Jeopardy, Medicaid, Medicare Enrollment, Nursing Home, Skilled Nursing Facility, SNF
Benesch
Ari J. Markenson, JD, MPH
Janet K. Feldkamp RN BSN LNHA CHC JD
Robert W. Markette, Jr. CHC
W. Clifford Mull
Frank W. Carsonie
Daniel J. O'Brien
Benjamin J. Parsons
Meredith L. Rosenbeck
Alan E. Schabes
