This past July, the Federal Communications Commission (“FCC”) released a ruling (the “Ruling”) interpreting the Telephone Consumer Protection Act (“TPCA”) restrictions on certain communications to wireless telephone numbers. The Ruling significantly restricts business’ ability to use auto-dialers and artificial / prerecorded voices for contacting wireless telephone numbers, including via text message (“automated contact system ”), prior to obtaining customer consent. Fortunately for the many health care providers who rely on this type of technology for important patient correspondence such as appointment reminders, the FCC has provided a significant exception for providers’ automated contact systems that meet certain criteria set forth in the Ruling. While the criteria are not overly burdensome, they are numerous and specific, so health care providers with automated contact systems should review them carefully to ensure ongoing compliance with the TPCA.
Following the Ruling, health care providers with automated contact systems must either obtain patient consent prior to using automated contact systems, or be sure that their automated contact system comply with the Ruling. Generally, to be exempt from obtaining prior express consent from patients calls to wireless numbers using automated contact systems:
- must not be charged to patient-recipients;
- must be for specific, health-related purposes;
- must include easy opt-out options; and
- are subject to volume and brevity restrictions.
The Ruling describes in greater detail the steps that health care providers must take to meet the above standards.
The FCC ruling is available here. Contact a member of the Benesch team if you have any questions about your automatic contact system after the FCC’s recent ruling.
Ohio’s transition to Medicaid managed care continues. The Ohio Department of Medicaid, the contracting agency with the 5 managed care companies now providing services to Ohio’s dual eligible population is [providing more information to Ohio providers during this transition period. Those dual eligible (eligible individuals for both Medicare and Medicaid) are being transitioned into these managed care private sector insurance programs. Some providers have been experiencing technical difficulties in submitting claims under the new managed care systems and providers are frustrated with slow payments. An updated released by the Ohio Department of Medicaid provides some statistics by region on the number of submitted claims and percentages of paid claims within 30 days of submission. The information provides a link to the Provider Payment Technical Assistance program to work with providers on a case-by-case basis to assist in resolution of issues and to resolve payment concerns. The Ohio Department of Medicaid issuance that includes the Provider Payment Technical Assistance link can be found at http://healthtransformation.ohio.gov/LinkClick.aspx?fileticket=V9a0WTwYchs%3d&tabid=105
Posted in Adult Home, Ambulance, Ambulatory Surgery Centers, Assisted Living, Clinical Laboratory, Clinics, Diagnostic Testing, Durable Medical Equipment, Group Home, Health Care Providers, Home Health, Hospice, Hospital, Intermediate Care Facility, Long Term Care Hospital, Medicaid, Nursing Facility, Nursing Home, Occupational Therapy, Ohio, Participation, Pharmacy, Physicial Therapy, Physician Assistants, Physicians, Residential Care, Skilled Nursing Facility, States
A company operating diagnostic testing facilities in New York has agreed to pay $13.65 million to the federal government and $1.85 million to New York and New Jersey for a total of $15.5 million in penalties to settle claims it falsely billed federal and state health care programs for tests that were not performed or not medically necessary and for paying kickbacks to physicians. The company denies liability for the allegations that are part of the settlement.
The settlement resolves allegations that between 1999 and 2010 the radiology group submitted false claims to Medicare and state Medicaid programs in New Jersey and New York for Three Dimensional reconstructions of CT scans that, according to the complaint, were medically unnecessary, were not ordered by the treating physicians, and in some cases were never actually performed or interpreted. These scans are often used in orthopedic, cardiovascular and neurologic imaging, including to visualize complex fractures, tumors in the lungs or soft tissues, and cardiac issues. In addition, the group allegedly submitted false billings for expensive imaging services, including retroperitoneal ultrasounds, Doppler scans, transrectal ultrasounds and pelvic x-rays. These imaging services allegedly resulted in a total of more than 40,000 false claims made to the New York Medicaid program. Continue reading
Posted in Acute Care, Anti-Kickback, Compliance Programs, Corporate Integrity Agreements, DHHS, Diagnostic Testing, Florida, Fraud and Abuse, General, Health & Human Services, Health Care, Health Care Providers, Medicaid, Medicare, New Jersey, New York, OIG, Physicians, Reimbursement, Self-Referral, Settlements
Tagged Ancillary Arrangements, False Claims Act, Medical Necessity, Radiology, Stark
The Office of the Inspector General (“OIG”) issued a 2014-2018 strategic plan including outlining the visions, goals, and priorities of that office for the upcoming several years. The plan sets forth four goals: 1. Fight fraud, waste and abuse; 2. Promote quality, safety, and value; 3. Secure the future; and 4. Advance excellence and innovation. Each goals is identified with several priority areas that support the stated goal. The report can be found at the OIG’s website http://go.us.gov/WdbV
Posted in Acute Care, Ambulance, Ambulatory Surgery Centers, Anti-Kickback, Assisted Living, Clinical Laboratory, Clinics, Community Based Care, Compliance Programs, Continuing Care, Diagnostic Testing, Disability, Durable Medical Equipment, Fraud and Abuse, General, Health Care, Health Care Providers, Health Care Workers, Health Information Privacy, HIPAA, Home Health, Hospice, Hospital, Intermediate Care Facility, Long Term Care, Long Term Care Hospital, Medicaid, Medicare, Mental Health, Nursing Home, Occupational Therapy, OIG, OIG Reports, OIG Work Plans, Out-Patient Care, Palliative Care, Pharmacy, Physicial Therapy, Physician Assistants, Physicians, Post Acute Care, Primary Care, Regulatory Compliance, Rehabilitation, Rehabilitation Hospital, Residential Care, Senior Housing, Skilled Nursing Facility, Supplier, Transportation
On October 9, 2013, the US Department of Health and Human Services Office of the Inspector General’s (OIG) Office of Evaluation and Inspections (OEI) issued a report (OEI-05-12-00340) entitled “Questionable Billing for Polysomnography Services.” The report found that Medicare paid nearly $17 million for sleep study (polysomnography) services that did not meet one or more of the three Medicare requirements and that 180 providers demonstrated patterns of questionable billing for these services. The OIG chose to study this issue because Medicare spending for sleep study services rose from $407 million to $565 million from 2005 to 2011, and fraud investigators and sleep medicine professionals have identified specific vulnerabilities regarding polysomnography services. The findings of the OIG’s report are significant because just as we accurately predicted that the OIG’s December 2010 Report: “Questionable Billing by Skilled Nursing Facilities” would generate increased investigations of therapy services for skilled nursing facilities (“SNFs”), the findings in this Report represents an area in which sleep study service providers can also expect increased enforcement. Continue reading
Posted in Clinical Laboratory, Diagnostic Testing, Durable Medical Equipment, Fraud and Abuse, Health Care, Health Care Providers, Hospital, Medicare, OIG, OIG Reports, Self-Referral
Tagged Centers for Medicare and Medicaid Services, DME, Durable Medical Equipment, Hospital, Medicare, Physician, Polysomnography, Sleep Study Centers
Compliance program fatigue is nothing new. Over at least the last 15 years, health care organizations have jumped in head first, put together detailed manuals and taken the plunge. However, reimbursement cuts, quality initiatives, RACs, ZPICs, whistleblowers, physical plant renovations and simply significant industry challenges got in the way of sustaining an efficient and effective compliance effort. Health care organizations have also become desensitized to the barrage of compliance education, enforcement press releases, audits and reviews and other shock-value communications on the importance of regulatory compliance. In that vein, this very article may get lost in the shuffle, although, we hope it doesn’t.
An efficient and effective compliance effort with your organization is extremely important, if only as an insurance policy against government scrutiny. Additionally, the Patient Protection and Affordable Care Act of 2010, H.R. 3590 (“ACA”) includes requirements that CMS implement mandatory compliance program requirements for all providers and suppliers. In a distinct section of ACA, nursing home mandatory compliance programs were given a specific implementation timeline. Continue reading
Posted in Acute Care, Adult Home, Ambulatory Surgery Centers, Assisted Living, Clinical Laboratory, Clinics, Community Based Care, Compliance Programs, Continuing Care, Diagnostic Testing, Disability, Durable Medical Equipment, Fraud and Abuse, Group Home, Health Care, Health Care Providers, Health Information Privacy, Health Reform, Home Health, Hospice, Hospital, Intermediate Care Facility, Long Term Care, Long Term Care Hospital, Medicare, Mental Health, Nursing Facility, Nursing Home, Occupational Therapy, Out-Patient Care, Palliative Care, Pharmacy, Physicial Therapy, Physician Assistants, Physicians, Post Acute Care, Primary Care, Program Integrity, Regulatory Compliance, Rehabilitation, Rehabilitation Hospital, Residential Care, Senior Housing, Skilled Nursing Facility, Supplier
On June 29, 2012, the OIG issued a favorable Advisory Opinion, No. 12-08, concerning a proposal for an independent diagnostic testing facility (the “IDTF”) to hire a physician (the “Physician”) to read and interpret sleep test studies when the Physician is closely related to the majority owners of the IDTF and is further employed by a company that also employs other potential referral sources (the “Proposed Arrangement”). Continue reading
Posted in Anti-Kickback, Community Based Care, DHHS, Diagnostic Testing, Fraud and Abuse, Health & Human Services, Health Care, Health Care Providers, Medicare, OIG Advisory Opinions, Physicians, Primary Care, Program Integrity, Regulatory Compliance