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DMEPOS Competitive Bidding Basics: The 5 W’s

April 10th, 2019 by

competitive biddingBy: Michael Silverman

WHO (does it impact)?

Any Medicare enrolled DMEPOS supplier that desires to service a Medicare Part B beneficiary with any medical equipment or device that is included in Medicare’s Competitive Bidding Program.

WHAT (is competitive bidding and what DMEPOS supplies are covered)?

In a nutshell, it’s essentially this: if a DMEPOS supplier wants to service a Medicare Part B patient with any of the following medical supplies covered by Medicare’s Competitive Bidding Program, such supplier must submit and win a ‘bid’ to provide such item in each and every geographic region covered by the Competitive Bidding Program in which they wish to be able to service beneficiaries within. read more

TCPA Class Action Litigation Alert: Ruling on $23M Liability for Faxed Prescription Requests

February 12th, 2019 by

TCPA Class Action LitigationBy: Michael Silverman

On February 11, 2019, the Hon. Judge John Z. Lee issued an impactful opinion (msj opinion Case 114-cv-05602) in high-stakes class action litigation that has been pending for more than four years, ruling on a Motion for Summary Judgment that the Defendant’s faxed prescription requests were not unsolicited advertisements in violation of the Federal Telephone Consumer Protection Act (“TCPA”).

Here is some background on the case: Over the period of several months in 2013, the Defendant, a DME/pharmacy supplier, sent six prescription requests via facsimile to a doctor for breathing medication on behalf of a patient. Problem was, unbeknownst to the Defendant, the prescription requests were being sent to the wrong doctor.  read more

CMS Home Health Moratorium Expires

February 11th, 2019 by

CMS Home Health MoratoriumBy: Dave Davidson

In July 2013, CMS issued a moratorium on enrolling new home health providers in Medicare, Medicaid and the Children’s Health Insurance Program in specific counties in Florida and Illinois.  The moratorium was subsequently expanded to counties in Texas and Michigan.  And in August 2016, the moratorium was expanded to cover those entire states. The stated purpose of the moratorium was to allow CMS to address the “fraud, waste and abuse” it had identified in those states, and it was consistently renewed by CMS every six months for the past five years. read more

DME Regulation: The Government’s CID Powers are not Unlimited

February 5th, 2019 by

dme regulationBy: Matt Fischer

The Department of Justice (DOJ) has recently aimed its investigatory efforts under the False Claims Act (FCA) to the durable medical equipment (DME) industry.  One area of DME regulation focus has been on diabetic shoe and insert manufacturers.  In its arsenal of investigative tools, the DOJ has the ability to issue Civil Investigative Demands (CIDs).  However, there are limits to the DOJ’s investigatory powers.  If a CID is received, DME suppliers need to be aware of the limitations placed on the government and what initial steps need to be taken.  read more

Florida Healthcare Law Firm Sponsors Attorney Jacqueline Bain on Honor Flight

October 24th, 2018 by

By: Jackie Bain

Earlier this year, Jeff and Autumn and I had a conversation about my motivations and passions outside of the law. We all knew that I was professionally passionate about compliance but they didn’t know that I’ve been personally passionate about veterans and their stories since I was in college. I majored in European history and concentrated on modern history including, of course, World War II. The final for one class was to write the story of someone who lived through the war, whether in military service or on the home front. I’ve been hooked on seeking out veterans’ personal stories of the war ever since.

A couple of years ago, a friend went on her first Honor Flight, and its something I’ve wanted to do ever since. Honor Flight’s primary purpose is to honor our veterans by taking them to visit their war memorials in Washington D.C. Honor Flight was founded by Earl Morse, Physician Assistant and Retired Air Force Captain who worked in a Department of Veteran Affairs clinic in Springfield, OH. When the World War II Memorial opened in 2004, Earl asked one of his patients who had served in World War II if he would be visiting his memorial. He was disheartened to learn that the vet couldn’t afford to travel to his memorial. Earl also happened to be an amateur pilot, and arranged for several small planes to transport his patient and his comrades to the memorial erected to honor them. Now, 14 years later, Honor Flight has hubs all over the nation and a waiting list of 35,000 World War II, Korea and Vietnam veterans waiting for their chance to fly. The flights are entirely free for veterans. read more

Direct Primary Care Agreements and the Relationship with Chiropractic Medicare Covered and Non-Covered Services

October 8th, 2018 by

chiropractic medicareBy: 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

FARR Certification: Get the Facts

June 26th, 2018 by

FARR Certification: Get the Facts

The recent petition for Declaratory Statement filed with the Department of Children and Families on behalf of our client focuses on one thing: whether the FARR certification requirements for Recovery Residences also apply to facilities licensed by DCF to provide Day and Night treatment with community housing and to Res-5 housing.

Another FARR Flaw: Get the Facts

June 21st, 2018 by

FARR certificationAttorneys from the Florida Healthcare Law Firm will hold a live call to present an urgently needed update regarding FARR certification.

The recent petition for Declaratory Statement filed with the Department of Children and Families on behalf of Amethyst Recovery Center focuses on one thing: whether the FARR certification requirements for Recovery Residences also apply to facilities licensed by DCF to provide Day and Night treatment with community housing and to Res-5 housing.  A review of FARR recovery residence certification shows that there is significant conflict with DCF requirements for licensure of treatment facilities that have a housing component.  There are no referrals to and from the community housing component of Day and Night or for Res 5: patients are simply housed under the DCF licensed component while in treatment.  Referrals from Recovery Residences to addiction treatment facilities are generally made for individuals who are seeking treatment, not for housing.

Day and Night Treatment Providers with community housing may make referrals for individuals who have completed inpatient treatment, requiring them to step down to an outpatient provider. Many times, clients desire to live in a recovery residence to maintain their sobriety.   In that case, it would be appropriate for the Day and Night Treatment Provider to refer to a FARR-certified recovery residence.

When asked about why Amethyst filed for clarification, Pamela Springer, Chief Operating Officer with Amethyst Recovery Center stated, “Amethyst supports FARR’s mission and the State of Florida’s requirement for recovery residence certification. However, thus far, DCF has indicated to Amethyst Recovery Center that it does not require FARR certification for licensed community housing.  FARR has stated to us and other providers that Day and Night treatment with community housing must obtain FARR certification or they will be in violation of the law.  This is the reason we sought clarification from DCF”.

If history teaches anything, it’s to learn from it.  The addiction treatment industry can’t afford to sit idly by and watch.  Uniform application of the law is essential to avoid unfair, unreasonable and unintended results.  Step up; show up. Register for FREE: https://attendee.gotowebinar.com/register/4977722626987986435 and stand up for your rights under Florida law.

A Medicare Provider Reminder From CMS and OIG: Report Your CHOW

April 19th, 2018 by

medicare providerBy: Matthew Fischer

Due to financial and regulatory constraints, many companies are merging or purchasing other healthcare companies.  However, prior to closing any transaction, these companies need to first determine whether government agencies must be provided advance notice of the change of ownership (CHOW). As an example, if Medicare is involved, these companies might be required to report the CHOW.

This issue is not one to dismiss or ignore because if companies fail to comply, they face significant penalties.  In a recent “MLN Connects” newsletter, the Centers for Medicare & Medicaid Services (CMS) issued a reminder to report changes in ownership.  The newsletter cites to an Office of Inspector General (OIG) report from 2016 that found a substantial amount of ownership changes were not being reported.  read more

Pre-Emptive Strike to ADA Claims are Coming Your Way!

April 3rd, 2018 by

By: Randy Goldberg

I previously wrote an article about the plague of “ADA Testers” infiltrating our businesses and medical practices with non-sensical claims of ADA non-compliance.  Don’t get me wrong, I fully support the need for ADA compliance and providing access to persons with disabilities.  When I was a police officer, I loved to write tickets for people who were parked in handicapped spots when they were not authorized to do so by law.  Such conduct by these disrespectful individuals, was like sticking up a middle finger to persons with disabilities.  However, there needs to be a way of addressing ADA compliance without allowing self-serving cannibalistic attorneys and professional plaintiffs from profiting from their cottage industry.

The Florida legislature has taken steps to do just that.  As of July 2017, after the enactment of Florida Statute §553.5141, there is a mechanism in place to allow owners of “places of public accommodations” (i.e. businesses and medical offices that are open to the public)[1] to take a pre-emptive strike against such claims.   read more