With insight and analysis from expert attorneys who represent physicians and other healthcare professionals in all phases of their practice, the Physician Law Blog is the go-to source for physicians, nurses, chiropractors, dentists, physical therapists, and other allied health professionals interested in learning more about issues impacting their practices every day.

Will Missouri be Next to Allow Electronic Monitoring Devices in Long Term Care Facilities?

Currently five states – Illinois, New Mexico, Oklahoma, Texas and Washington have laws requiring long term facilities to allow residents to request monitoring devices in resident rooms. Utah currently has legislation under consideration to allow monitoring, but the Utah legislation restricts the use of such devices to assisted living communities. Now, Missouri is looking at…

CMS Changes the Manual Medical Review of Therapy Claims Above the $3,700 Threshold and Extends Therapy Cap Exception

On February 9, 2016, CMS issued an update announcing changes related to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), signed into law on April 16, 2015. The changes extend the therapy cap exception process through December 31, 2017. MACRA also modifies the requirement for manual medical review for services over the $3,700…

Illinois Authorized Electronic Monitoring in Long-Term Care Facilities Act

As many of you are aware, on January 1, 2016, the Illinois Authorized Electronic Monitoring in Long-Term Care Facilities Act (the “Act”) became effective. This Act imposes various responsibilities on long-term care facilities in Illinois to allow residents to engage in electronic monitoring. The Department of Public Health (“IDPH”) also has certain responsibilities under the…

Hospitals Beware – Inpatient Kyphoplasty Procedures Remain a False Claims Act Target

Kyphoplasty is a minimally invasive procedure used to treat certain spinal fractures often due to osteoporosis.  Since the filing of a qui tam action, more than 130 hospitals have entered settlements with the Department of Justice (DOJ) totaling approximately $105 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures. On December 18, 2015,…

Another $750,000 HIPAA Settlement – Focus on Need for Risk Analysis

The HIPAA Final Rule has been in effect since 2013, but HIPAA settlements following breaches continue to be reported. If you think the need for a risk analysis under HIPAA is not important, think again! On December 14, 2015, the Department of Health and Human Services (HHS) announced another $750,000 HIPAA settlement with the University…

False Claims Update: OIG Continues to Focus on Ambulance Services

Reduction of fraud and abuse remains a focus of the government’s efforts to ensure providers accountability.  Recently, the Department of Justice (DOJ) announced a $3.199 Million settlement of alleged False Claims Act violations resulting from an ambulance “swapping” arrangement between a skilled nursing home and ambulance service (Regent settlement). Once again, the Department of Justice…

Triple-S to Pay $3.5 Million Plus Adopt a Robust Corrective Action Plan

Office of Civil Rights (OCR) Director Jocelyn Samuels has made it clear that the “OCR remains committed to strong enforcement of the HIPAA Rules.” The latest settlement announced on 11/30/15 concerning Triple-S, an insurance holding company offering a wide range of insurance products and services, demonstrates just how committed the OCR is when it comes…

Anti-Kickback Update – HHS-OIG Settles Ambulance Swapping Case $3 Million Settlement from Nursing Home in Ambulance Swapping Case

Demonstrating the government’s commitment to combat health care fraud and keeping providers accountable, the U.S. Attorney’s office of Southern District announced that Regent Management Services L.P., a long term provider, agreed to pay approximately $3.199 Million to settle allegations that it received kickbacks from ambulance companies for referrals of Regent’s Medicare and Medicaid patients needing…

New Study Detailing Differences Between LTC and Retail Pharmacies

The Senior Care Pharmacy Coalition (SCPC) recently released a study comparing the differences between LTC and Retail Pharmacies. I thought this study may be of interest to some firm clients, who have LTC pharmacies as part of their businesses. Many assisted living facilities (ALFs) and skilled nursing facilities (SNFs) provide pharmacy services for residents in…

HIPAA News – $750,000 Settlement Following Stolen Laptop

Ever wonder if the Office of Civil Rights (“OCR”) is serious about the requirements for a HIPAA Security risk analysis and policy specific to removing hardware and electronic media containing ePHI from a covered entity’s facility? Yes, the OCR is extremely serious about those requirements as Cancer Care Group, P.C. (“Cancer Care”), a radiation oncology…

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This information is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship. © 2014 Sandberg Phoenix & von Gontard P.C. All Rights Reserved.

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