Health law is the federal, state, and local law, rules, regulations and other jurisprudence among providers, payers and vendors to the healthcare industry and its patient and delivery of health care services; all with an emphasis on operations, regulatory and transactional legal issues.
Have a question regarding Medicare recoupment, hiring a new physician, selling a practice, licensing or anything else? You have plenty of resources to get information from and you can hire the assistance of an attorney. However, those avenues can only help so much and you eventually will need the guidance and help of an experienced legal team that can help you in multiple areas including:
Get exact information: Rather than getting your information from a blog site or forum, you are getting it from an experienced attorney who knows exactly what it takes to get a favorable outcome in your case. The problem with blogs isn’t that the information is wrong; it’s that it sometimes doesn’t apply to your circumstances which is why you want to avoid relying on it.
Multiple areas to cover: Have a single problem, a lawyer will handle it. Have multiple problems over the next several years and you want to work with a legal team that can handle each and every one of them, saving you time and money and making the entire experience very simple.
Be ready for the next issue: Again, you are running a business in the medical field. You will have several matters that come up which require legal assistance. Having a legal team you already have experience with, who knows the ins and outs of every type of case or situation you may need assistance with is a great benefit to have.
When it comes to Medicare recoupment cases, you want to make sure that you can rely on an experienced legal team to handle your case from beginning to end. Our team is not only well experienced in handling these cases, but we have a high success rate. When you are searching for an attorney, you should always base your decision on the track record of that lawyer, the services they can provide you as well as their ability to take on any challenge and provide you with the best representation possible.
What separates The Florida Healthcare Law Firm from other attorney’s is that we have an entire team of dedicated lawyers who specialize in multiple areas of medical law including; implementing policies and procedures, selling or buying a healthcare business, opening a treatment center, Medicare recoupment and so much more. If you would like to learn more about our services, how we can assist you with your case as well as your legal options, contact us today to speak with an experienced counselor or visit our site to learn more. We have the resources, dedication and experience needed to help you win your case and we are ready to help you.
In 2014, the Centers for Medicare and Medicaid Services (CMS) started a program that combined the process of reviewing a sample of claims with providing follow up education as a way to help reduce errors in the claim submission process. This is called the Targeted Probe and Educate Program (TPE). The goal of the program is to help providers and suppliers identify errors made and quickly make improvements. CMS has acknowledged that since its inception the program needs improvements and that this type of review can be burdensome. Most providers and suppliers never experience a TPE review; however, for the ones that receive notification, here are the top five things you should know before moving forward:
When providers or suppliers self-report overpayments to Medicare Part C Managed Care organization, there is some uncertainty on what lookback period applies and whether there actually is an overpayment obligation. Is it Medicare’s 60-day overpayment rule that applies or do the Managed Care Part C organizations impose a different lookback period for overpayments?
CMS (The Centers for Medicare & Medicaid Services) published its Final Rule clarifying the procedures applicable to the statutory requirement under the Affordable Care Act (“ACA”) for providers and suppliers to self-report and return overpayments. (The Final Rule was published on February 12, 2016). The Final Rule applies to Medicare Parts A and B and addresses the procedures that a provider or supplier need to follow to investigate, identify, quantify to self-report and return an overpayment. The Final Rule clarifies the obligations of Medicare providers and suppliers to report and return overpayments for claims originating only under Medicare Parts A and B. The final rule does not address, or reference, the obligations of providers to return overpayments to Medicare Advantage organizations for Part C claims. read more
On November 1, 2018, a federal court judge in the U.S. District Court for the District of Columbia granted a motion for summary judgment in favor of the American Hospital Association (AHA) ordering the U.S. Department of Health and Human Services (HHS) to clear the Medicare appeal backlog by fiscal year (FY) 2022. If you have not been following this litigation, the AHA initially filed suit in 2014 against the Secretary of the U.S. Department of Health and Human Services (HHS) requesting an order from the court mandating the Office of Medicare Hearings and Appeals (OMHA) within HHS to comply with its statutory deadlines (i.e. to issue a decision within 90 days). Following brief review by the U.S. Court of Appeals and upon the case being before the district court for a third time, the case has finally reached a resolution.
In short, HHS agreed that due to recent funding, compliance is possible within four years. Accordingly, the judge set the following deadlines for HHS and OMHA: read more
There are perfectly compliant ways to engage with healthcare marketers, and then there’s this; here are some of the latest real-life examples:
“DME BRACE CAMPAIGN – $40 to $150 PER LEAD PER BRACE”
“DME DIABETIC LEADS $40 PER LEAD, INSURANCE AND DOC INFO INCLUDED”
“PAIN CREAM/LIDOCANE LEADS FOR SALE, RX INCLUDED”
These marketers are seemingly holding auctions for the sale of federally protected patient health information out to the highest bidder! Couldn’t make this stuff up – if you’re in this industry, a quick gander at your (business) social media platforms will quickly confirm it. read more
Regulatory compliance is a mandatory investment for any healthcare business owner looking to stay out of serious and personal legal peril, let alone one hoping to keep their company viable.
Yet there is seemingly an onslaught of providers that blatantly run afoul of many of these regulations, knowingly or not, or those that believe they may have found a loophole.
Concerning the latter, there is an important mantra that such DME and pharmacy providers should remember and live by: “[W]hat a provider cannot do directly, it cannot do indirectly through an intermediary.”
Marketing for DME – What exactly am I talking about?
DME providers enrolled with CMS (should) know they cannot solicit or ‘cold call’ Medicare Part B beneficiaries, per the Federal Anti-Solicitation Statute, and that they cannot offer anything of value to a potential patient that could induce them to utilize them as a provider, in accordance with the Beneficiary Inducement Statute. read more
Multiple health care businesses have scored wins this year in their fight to prevent CMS from recouping payments before having an opportunity for an Administrative Law Judge (ALJ) hearing. The similarity? They each sought a temporary injunction in federal court. Arguing that the alleged recoupments would cause the businesses to close, employees to lose their jobs and patients would be forced to change their providers, the businesses were granted temporary injunctions enjoining CMS from starting recoupment until the ALJ appeal stage had reached a conclusion. read more
By: Susan St. John As many chiropractors are likely aware, they cannot “opt-out” of Medicare. Even if a chiropractor has not enrolled to be a Medicare provider, a Medicare beneficiary may require the chiropractor to submit a claim to or bill the Medicare program on his/her behalf for chiropractic services rendered. For chiropractic services to be covered by Medicare, the patient must have a condition necessitating treatment and manipulative services rendered must have a direct therapeutic relationship to the patient’s condition. The manipulative services must provide a reasonable expectation of recovery or improvement of function. Further, the Medicare patient’s condition must be acute and not a chronic subluxation without objective clinical improvement anticipated. Manipulative treatment beyond treating the acute phase, that is, a chronic condition, is considered maintenance therapy and is not covered. Thus, a chiropractor needs to carefully consider at what point a Medicare beneficiary’s treatment becomes palliative or maintenance therapy which would not be covered and thoroughly explain this to the patient. The chiropractor has a duty to let the patient know when treatment is no longer curative or therapeutic, but rather maintenance therapy. read more
The transition from paper medical records to electronic medical records has brought with it many conveniences and some unintended consequences. One example of an unintended consequence is cloning in the medical record. Cloning is copying and pasting previously recorded information from a prior patient note into a new patient note.
Providing quality medical care is only one part of the job. Appropriately documenting that care in order to be paid for your efforts is another. And while medical professionals are trained at length to provide care, hardly any are aware of the potential pitfalls associated with improper documentation.
As noted in Opting Out of Medicare Part I, opting out of Medicare may be an option for some physicians and practitioners. After determining whether you are eligible for opt-out or if it is financially feasible, there are a few other considerations. Part I discussed the Private Contract a physician must enter into with each Medicare beneficiary he or she treats; here, we will address the opt-out affidavit and other nuances of opting out. Let’s get started!
The Medicare Opt Out Affidavit
Provisions in an Opt Out Affidavit are similar to provisions that must be included in the opted out physician’s or practitioner’s private contract with Medicare beneficiaries. The opt-out affidavit must state that the physician or practitioner will only provide services to Medicare beneficiaries with whom they have a written and signed private contract and that the physician or practitioner will not submit claims to Medicare on behalf of Medicare beneficiaries. Medicare does allow for an exception here, but that is only when an opted out physician or practitioner treats a Medicare beneficiary who is not under private contract, and that beneficiary presents with a medical emergency or urgent care problem. Keep in mind, that if a Medicare beneficiary presents with a medical emergency or urgent care problem, the physician or practitioner cannot require that patient to sign a private contract at that time. read more
In 2012, the American Hospital Association (AHA) along with three member hospitals filed a lawsuit against the U.S. Department of Health and Human Services (HHS) for the agency’s failure to meet the 90 day decision requirement at the Administrative Law Judge (ALJ) level known as the Office of Medicare Hearings and Appeals (OMHA). Through the years, the case has moved back and forth between a federal district court and federal appeals court in the District of Columbia. Most recently in March, a federal district court judge ordered the AHA to expand on its suggestions it has made over the course of its litigation for how HHS can clear the ever-growing backlog and additionally, explain why the current procedures are insufficient. read more