Lifewatch Services, Inc., an Illinois-based company, recently agreed to pay the United States $18.5 Million to resolve False Claims Act allegations filed by two separate whistleblowers. In addition to the settlement, Lifewatch entered into a comprehensive Corporate Integrity Agreement with the Office of Inspector General.
The whistleblower complaints alleged that Lifewatch improperly billed Medicare for ambulatory cardiac telemetry (“ACT”) services. Continue reading
On April 5, 2012, OSHA announced its new national emphasis program targeting nursing home and residential care facilities. This program is similar to the program OSHA embarked on in 2003-2004. However, the new program will also focus on workplace violence. The program is designed to address the protection of workers from serious safety and health hazards that are common in medical industries. National emphasis programs target specific hazards in an industry for a three-year period. This program will target nursing homes and residential care facilities in an effort to reduce occupational illnesses and injuries. Continue reading
On April 6, 2012, CMS issued a memorandum to state survey agency directors (S&C: 12-26-HHA) informing them that, effective immediately, Home Health Agencies (HHAs) that have had their billing privileges deactivated must undergo recertification surveys before billing privileges can be reinstated. The change in policy was enacted with the The Home Health Prospective Payment System (HHPPS) final rule CMS-1560-F, which amended 42 C.F.R. 424.540(b)(3), effective January 1, 2010.
As CMS noted, a deactivation of billing privileges most commonly occurs when the provider fails to submit a Medicare claim for 12 consecutive months. During the deactivation period, the HHA’s Medicare provider agreement remains in place and the HHA will retain the same CMS Certification Number (CCN) once the recertification survey has been completed. No new provider agreement will be required.
For the full text of the Survey and Certification Letter, please see —> S&C: 12-26-HHA
Members of our Health Care Practice will be attending and speaking at the Health Care Compliance Association’s 16th Annual Compliance Institute, April 29 – May 2, 2012, in Las Vegas Nevada. Two of our health care partners will be speaking on the following topics at the Institute -
2012 OIG Work Plan: Priorities and Concerns for Post Acute Care Providers
Alan Schabes, Esq. will be speaking with David Cade, Deputy General Counsel of the U. S. DHHS in a session entitled – 2012 OIG Work Plan: Priorities and Concerns for Post Acute Care Providers on Monday, April 30th at 4:30-5:30PM
Quality of Care Issues: Prevention and Response
Ari J. Markenson, J.D., M.P.H. will be speaking with Robert Hussar, Counsel, Manatt, Phelps & Phillips, LLP in a session entitled Quality of Care Issues: Prevention and Response on Monday, Monday, April 30th at 11AM-12PM Continue reading
In recent years, home health agencies (“HHAs”) have been under a tremendous amount of scrutiny due to perceived concerns involving fraud and abuse. To that end, CMS assigned newly enrolling HHAs to the high-risk screening level in 2011, and the OIG responded by significantly increasing its focus on HHAs, as evidenced by the numerous OIG initiatives targeting HHAs contained within the OIG’s 2012 Work Plan. Many news outlets have also been critical of HHAs, particularly with respect to compliance with Medicare coverage requirements.
In a new report (the “Report”) issued by the OIG in March of 2011, however, the OIG released data which indicates that HHAs are doing a fairly good job in complying with Medicare coverage requirements. Continue reading
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Posted in Community Based Care, Fraud and Abuse, Health Care, Health Care Providers, Home Health, Medicare, OIG, Participation, Program Integrity, Regulatory Compliance, Reimbursement
Representatives of CMS’ Survey and Certification Group provided valuable insight into the top 10 survey citations/deficiencies for hospice providers at the National Hospice and Palliative Care Organization’s, 27th Annual Management and Leadership Conference last week. The informative session discussed survey deficiencies, the implementation of quality measures as well as CMS’ efforts to reform the hospice reimbursement system. Understanding the top 10 survey deficiencies is an important part of planning overall regulatory compliance initiatives and day to day operations. The top ten citations relate broadly to the areas of care planning, supervision and training of employees, and the provision of certain counseling services. Continue reading
Health care providers enter into agreements with vendors on a daily basis. Providers have agreements with suppliers for items and services, such as – durable medical equipment, medical supplies, EKG/Holter monitoring services and pharmaceuticals. Providers also have agreements with ancillary providers, like rehabilitation therapists, audiologists, psychologists, wound care professionals, and others.
Entering into and working with these types of agreements and arrangements can and does become a routine function of any provider. Often when providers treat these agreements as a routine day to day function, important compliance and business related concerns can get overlooked. An important element of the compliance function of any provider organization should include a periodic review of its vendor agreements and arrangements. Continue reading
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Posted in Anti-Kackback, Compliance Programs, Exclusion, Fraud and Abuse, Health & Human Services, Health Care, Health Care Providers, HIPAA, Medicaid, Medicare, OIG, Regulatory Compliance, Self-Referral
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
