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$1.2B Health Care Fraud Schemes Involving Telemedicine and Durable Medical Equipment Marketing Executives

April 9th, 2019 by

Via justice.gov – One of the largest health care fraud schemes investigated by the FBI and the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) and prosecuted by the Department of Justice resulted in charges against 24 defendants, including the CEOs, COOs and others associated with five telemedicine companies, the owners of dozens of durable medical equipment (DME) companies and three licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $1.2 billion in loss, as well as the execution of over 80 search warrants in 17 federal districts.  In addition, the Center for Medicare Services, Center for Program Integrity (CMS/CPI) announced today that it took adverse administrative action against 130 DME companies that had submitted over $1.7 billion in claims and were paid over $900 million. Read on…

Marketing for DME & Pharmacy Providers: Know Your Subcontractor!

November 13th, 2018 by

marketing for dmeBy: Michael Silverman

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

Telemedicine Contracts: Non Compete Agreements

March 9th, 2018 by

telemedicine lawBy: Karina Gonzalez

Healthcare practitioners are excited about the expansive geographic scope of practice in Telemedicine.  A licensed Florida physician can provide services in other states provided the physician is also licensed in the state where the patient is receiving the services. There are no geographical limitations if the delivery platform of technology provides voice and vision and where necessary videos for the Telemedicine/Telehealth visit.

As more and more physicians practice and contract to provide Telemedicine visits, one of the legal challenges we are facing is how to draft a restrictive covenant. The traditional reasonableness standards used to evaluate non-compete agreements just do not apply. What are you trying to restrict when the physician lives in Florida but has telemedicine practice with patients 500 miles away? read more

DME License, Operation and More in Florida – a Brief Legal Look

January 10th, 2018 by

DME operationBy: Susan St. John

So you are considering starting a home medical equipment aka durable medical equipment (HME or DME) business to provide products and services to patients in Florida (and perhaps in other states, but that’s a topic for another day). In addition to deciding what products and/or services you are going to provide and your physical location, there a few things you need to know, steps to be taken, and information to be collected, to apply for an HME/DME license in Florida to get up and going.

The Basics

Florida defines an HME provider as “any person or entity that sells or rents or offers to sell or rent to or for consumers, any HME and service or HME that requires HME services.” Section 400.925(7), Florida Statutes. Further, HME “includes any product as defined by the Food and Drug Administration’s Federal Food, Drug, and Cosmetic Act, any products reimbursed under the Medicare Part B Durable Medical Equipment benefits, or any products reimbursed under the Florida Medicaid durable medical equipment program. HME includes oxygen and related respiratory equipment; manual, motorized, or customized wheelchairs and related seating and positioning, but does not include prosthetics or orthotics or any splints, braces, or aids custom fabricated by a licensed health care practitioner; motorized scooters; personal transfer systems; and specialty beds, for use by a person with a medical need.” Section 400.925(6), Florida Statutes. read more

Telehealth Law Florida: Delivery System for Substance Abuse Services

January 9th, 2018 by

telemedicine lawBy: Karina Gonzalez

Telehealth law Florida is constantly evolving The latest example is found with Florida’s Department of Children and Families (DCF) recent proposed rule change which now includes a definition of Telehealth as a delivery system in substance abuse.  Telehealth can be used in treatment or prevention services through electronic communications from one site to another.  However, it does not include delivery of services using only the audio on a telephone, or e-mails, text messages, fax transmissions, US mail or other parcel service. Proposed Rule 65D-30.0031 (83) Definitions.

Telehealth services can be used in intensive outpatient, day or night treatment, day or night treatment with community housing, outpatient, interventions, aftercare, and prevention.   If a substance abuse provider plans on including telehealth services it must submit to DCF detailed procedures outlining which services it intends to provide. The provider will be responsible for the quality of the equipment and technology used in the telehealth service. Proposed Rule 65D-30.004 (20) Common Licensing Standards. read more

Telehealth Contract Review: How to Vet a Telehealth Opportunity

October 12th, 2017 by

telemedicine contractBy: Susan St. John

So you’ve been approached by a telehealth company to provide telehealth services to patients. What do you do next about this telehealth contract opportunity? Providing these services can be an opportunity to assist patients who cannot make it to a physician’s or practitioner’s office, and it’s an opportunity for a potential source of income. However, before you sign on the telehealth contract’s dotted line, you need to do a little background checking, a little investigation, to ensure the telehealth company you sign with is compliant with state and federal laws for providing telehealth services. In other words, perform due diligence in determining if this is the telehealth company for you.

So what should you look for in a telehealth company as a physician or practitioner presented with a telehealth contract? read more

Telehealth Practice Setup: 3 Easy Tech Steps

October 11th, 2017 by

telemedicine practiceBy: Frank Diaz, Guest Contributor

Floridians are all too familiar with the business and logistical hurdles bad tropical weather can create. However, even less expected are the everyday human errors such as an overzealous backhoe operator digging above a fiber optic cable and inadvertently cutting a data connection. The reality is that disruption can happen anytime, not just during hurricane season. The good news is that recent developments in technology provide a new way to both augment the practice of medicine and insulate a business against downtime. Telemedicine or telehealth is rapidly becoming an inexpensive and secure way to interact with patients and medical professionals just short of the tactile response from pressing flesh during an introductory handshake.

Granted, telemedicine and telehealth are generic terms that incorporate layers of many technologies. For simplicity’s sake we’ll discuss some of the most popular options for video conferencing, cloud based technology and virtualization. If that sounds intimidating just look past the buzzwords you may hear in commercials mentioning a certain character from a Sir Arthur Conan Doyle novel. It’s all elementary. See what I did there?
read more

Medicare Telehealth Basics

October 9th, 2017 by

Medicare TelemedicineBy: Susan St. John

If you are having issues with Medicare telehealth claim matters then you want to hire an experienced legal team that can guide you through the process, ensuring the best possible outcome. You also have the benefit of knowing that you are getting the best counsel for any legal matters and do not have to rely on amateur advisement like blogs and forums. These are some of the questions you can get answers to:

  • What experience do you have? When you hire an attorney to handle a legal matter for your business, you want them to be experienced and have a well established presence in this industry because there’s a chance they will be going up against insurance companies who have a lot of money and an experienced team of their own.
  • How can you help me with this situation? When you are dealing with this matter you want to make sure that everything is taken under consideration. For example, are you compliant with all the rules and regulations, new changes in policy or anything else that comes up? Do you have all the licensing you need to conduct business and so forth? An experienced team will make sure you have everything you need to move forward.
  • How can you help me in the future? One of the biggest advantages of hiring a law firm rather than an individual attorney is that we can assist you with several legal matters that come up in the future. Today you may need assistance with a contract for hiring a new doctor but a year from now it may be to purchase or sell a practice.

With the rise in services provided to patients via telehealth entities, it is important that both practitioners and patients understand what criteria must be met in order to provide and bill telehealth on behalf of Medicare patients. Here are a few of the basics.

First, “telehealth service” for Medicare purposes means “professional consultations, office visits, and office psychiatry services, and any additional service specified by the Secretary. To be eligible for payment, telehealth services must be rendered to an eligible individual, that is, an individual enrolled in Medicare, who receives telehealth services at an originating site from a physician or practitioner at a distant site via telehealth communications system. An eligible individual does not need to be presented by a physician or practitioner at the originating site to a physician or practitioner at a distant site, unless it is medically necessary. Determination of whether a presenting physician or practitioner is necessary at the originating site is made by the physician or practitioner at the distant site.

So, what is an originating site and what is a distant site? read more

Billing & Telehealth Payment for Services in Florida

October 4th, 2017 by

telehealth paymentBy: Jacqueline Bain

Here in Florida, where large portions of the population are as transient as migrating birds, doctors and other practitioners often experience a downturn in their practice during the spring and summer months. However, telehealth provides these doctors and practitioners an option to continue treating their patients from afar, provided certain legal and technical requirements are met. The Federal Government and Medicare have been at the forefront of outlining how these services of the future may be properly rendered, allowing for continuity of care in a controlled setting. Medicare, for instance, pays for a limited number of Part B services furnished by a doctor or practitioner to an eligible Medicare beneficiary. To understand how to provide these services, doctors and practitioners must first learn the language.

Key Terms

An “originating site” is where the eligible Medicare beneficiary is located at the time the telehealth service is furnished. Originating sites may be physician offices, hospitals, rural health clinics, Federally Qualified Health Centers, Critical Access Hospitals, Skilled Nursing Facilities, and Community Mental health Centers. Medicare Administrative Contractors pay originating sites an originating site facility fee for telehealth services through HCPCS code Q3014. read more

Telehealth Now Trending in Substance Abuse Treatment

September 27th, 2017 by

telemedicineBy: Karina Gonzalez

Most commercial health plans require that prior to admission to a substance abuse treatment facility, patients must have a face-to-face individual assessment by a licensed behavioral health clinician 72 hours prior to admission, to determine if the admission is both medically necessary and clinically appropriate.   Many potential patients reside in states outside of Florida (or a given destination),  so complying with a face-to-face requirement when a patient is in another state before admission is a challenge.  Telehealth is being increasingly utilized to evaluate these out-of-state patients and perform the necessary face-to-face evaluation in advance of arrival at a given facility. However, as with anything healthcare, there is a right way and a wrong way to implement this technology. In the coming weeks, we’ll be discussing many of the facets involved from telemedicine claims overpayments to Medicare telehealth law issues.