healthcare compliance

All posts tagged healthcare compliance

Controlled Substances Dispensing Gets Pharmacy in Trouble – AGAIN!

by admin on March 9, 2022 No comments

Yet another pharmacy owner was just convicted of unlawfully dispensing over 1.5 million doses of controlled substances, primarily oxycodone and hydrocodone. 

By: Karen Davila

In my last couple of articles, I’ve focused on the controls necessary to safely operate a pharmacy and dispense appropriate prescribed medications, including controlled substances.  And those of you who heed that kind of advice are likely to avoid the unwanted attention of law enforcement.  However, for those who continue to think they can operate with impunity, heads’ up:  the war against opioids in the U.S. is ongoing and enforcement activities are not slowing down.  Below is an article about this recent case out of Texas and some lessons we can all take away from what was reported.

In this most recent case, a federal jury in Texas convicted a Texas pharmacy owner (Carr) on March 7 of one count of conspiracy to unlawfully distribute and dispense controlled substances, four counts of unlawfully distributing and dispensing controlled substances, one count of conspiracy to launder money, and two counts of engaging in transactions in property obtained from the illicit activity.  Carr now faces up to 140 years in prison, among other consequences.

read more
adminControlled Substances Dispensing Gets Pharmacy in Trouble – AGAIN!

Real Risks of Caregivers on Continuing Care Community Property

by admin on February 15, 2022 No comments

Providing a high-quality and safe environment and care for vulnerable seniors is a top priority for continuing care communities (CCCs).  Senior communities that provide a full continuum for seniors aging in place (including independent living, assisted living, skilled nursing, and memory care) often focus their safety concerns and resources on the licensed areas of the community, where falls and skin breakdown are the subject of lawsuits.  Sometimes overlooked are the risks that arise when independent living residents bring their own personal caregivers into the community to support their needs.

Growing Use of Personal Caregivers

More and more seniors are finding safety and security in CCCs throughout the country.  And, as they age in place, maintaining that independence often involves the use of personal caregivers who come into the CCCs and create additional risks.  Each time a personal caregiver is allowed admittance to the CCC, real risk is created- and that risk can lead to legal liability, including:

  • Injury to other residents
  • Injury to the resident that hired the caregiver
  • Injury to the caregiver caused by other residents
  • Slip, trip and fall (or other general liability claims) by the caregiver against the CCC
  • Theft/damage to property

But there are a few basic steps that a CCC can do to reduce those risks, while still allowing residents their independence.  Here are some simple considerations:

read more
adminReal Risks of Caregivers on Continuing Care Community Property

OIG Revises Self-Disclosure Protocol

by admin on December 2, 2021 No comments

On November 8, 2021, The Department of Health & Human Services (HHS), Office of Inspector General (OIG) released a revised and renamed Provider Self-Disclosure Protocol (SDP), now known as the “Health Care Fraud Self Disclosure “protocol. The SDP was created in 1998, and the protocol can be used to voluntarily identify, disclose and resolve instances of potential fraud involving federal healthcare programs. As described on the OIG website, “Self-disclosures give persons the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.”

read more
adminOIG Revises Self-Disclosure Protocol

Mitigating the Risk of Personal Aides in Continuing Care Communities

by admin on September 28, 2021 No comments

continuing care community law personal aid liability risk managementMore and more seniors are finding safety and security in continuing care communities (CCCs) throughout the country.  And, while they want the increased safety and security, they do not want to lose their independence.  Aging in place and maintaining that independence often involves the use of various personal service providers (PSPs) who come onto the CCC campus and create new risks.  PSPs go by many names and perform many functions, including housekeeping, meal preparation, assistance with activities of daily living (bathing, grooming, eating), grocery shopping, dog walking, and driving the resident to various offsite appointments.

read more
adminMitigating the Risk of Personal Aides in Continuing Care Communities

SNF Reimbursement Model Leads to False Claims

by admin on July 6, 2021 No comments

Medical necessity is foundational to payment by government payers (Medicare, Medicaid, Tricare, FEHBP) for health care services.  If services are not medically necessary, any claims filed constitute false claims. In a recent DOJ False Claims Act (FCA) case, a civil settlement of a whistleblower action was reached in resolution of allegations that over a more than six-year period, a rehabilitation therapy contractor violated the FCA by causing the submission by 12 skilled nursing facilities (SNFs) of false claims for “medically unnecessary, unreasonable, and/or unskilled rehabilitation therapy services.”  Under the Settlement Agreement, the rehabilitation therapy provider agreed to pay $8.4 million to resolve the matter.

BACKGROUND ON SNF REIMBURSEMENT

In order to understand the case, it is important to understand (at least at a basic level) SNF reimbursement.  This case arises during the time period 2010-2016 when SNFs were paid by Medicare under the Resource Utilization Groups (RUGs).  By way of background, RUGs are a prospective payment model which includes a system of grouping a SNF’s residents according to their clinical and functional statuses which information derives from the minimum data set (MDS) assessment for the resident.  Soon after adoption, many SNFs and rehabilitation therapy providers adjusted their model of care delivery to increase the level of reimbursement.  The methodology created an incentive to deliver more therapy than skilled nursing services since those RUGs were reimbursed at a higher rate.

read more
adminSNF Reimbursement Model Leads to False Claims

Health Care Clinics Targeted For Medical Director Requirements

by admin on February 9, 2021 No comments

By: Zach Simpson

There have been a rise in cases recently, in which practices that operate under a Health Care Clinic License have been brought under scrutiny by insurance companies trying to recoup funds through any means possible. In an effort to claw back funds insurance companies are beginning to claim that medical directors are failing to meet their statutory obligations under Florida Law which in turn can have serious monetary repercussions. Due to the clinics allegedly failing to meet their statutory obligations the insurance companies are filing suit to recoup any payments made while violating the Health Care Clinic Act obligations, and to stall any future payments due until such cases are heard.

By law, a medical director must be a health care practitioner that holds an active and unencumbered Florida license as a medical physician, osteopathic physician, chiropractic physician, or podiatric physician. The type of services provided at a clinic may dictate who would be able to serve as a clinic’s medical director, because a medical director must be authorized under the law to supervise all services provided at the clinic.

read more
adminHealth Care Clinics Targeted For Medical Director Requirements

What to Do When The Government Comes Knocking

by admin on January 3, 2021 No comments

business meeting between healthcare professionals and govermentBy: Karen Davila

You do everything right.  You’re careful to dot your i’s and cross your t’s.  Compliance is hard-wired because you’re in an industry that’s highly regulated and you’ve built into your operations a series of compliance checks and balances.  However, even with strong controls in place, compliance efforts sometimes fall short– and whether you’re a physician group, a pharmacy, a durable medical equipment company, a home health agency, or any other health care provider, someday you might find yourself face-to-face with law enforcement officials or regulatory enforcement authorities.  What do you do?  How do you assure the most successful outcome with minimal business disruption?

Compliance is the foundation to mitigating the risks inherent in any health care operation.  Compliance can reduce the likelihood that regulators or law enforcement suddenly appear on your doorstep.  But preparation for emergencies and uncertainties is the key to reducing the risk that non-compliance leads to lengthy business interruption.  Although you may be saying “if”, you really should be thinking and acting more like “when”.  It costs everything to be ill-prepared and it costs very little to be well-prepared.  The following preparation can prevent much of the uncertainty that arises in these cases.

POLICIES AND PROCEDURES

First and foremost, make sure you have well-developed policies and procedures for what to do in such instances.  You should review these policies and procedures with your employees regularly, focusing on the importance of compliance.  Out of fear and uncertainty, employees can do things that create unnecessary challenges.  Educating them as to what their rights and responsibilities are will mitigate those risks.  Make sure your policies and procedures include the designation of who is in charge (“person in charge”) when the government does show up.

read more
adminWhat to Do When The Government Comes Knocking

Weave Compliance Into Your Practice For 2021

by admin on December 8, 2020 No comments

fhlf regulatory complianceBy: Jeff Cohen

A recent Department of Justice $500,000 settlement with a cardiology practice underscores the need for ensuring tighter compliance by medical practices.  There, the practice billed Medicare for cardiology procedures for which interpretive reports were also required.  Medicare paid for the procedures, but upon audit, CMS could not find the requisite interpretive reports.  The False Claims Act case settled for $500,000, but it’s likely that (1) the reimbursement by Medicare was far less, and (b) the legal fees behind the settlement weren’t too far behind the settlement amount!  Had the practice self-audited each year, would they have found the discrepancy?

Medical practices have felt the weight of price compression and regulatory load more than probably any segment in the healthcare sector.  They are doing far more for far less.  And regulations expand faster than viruses!  Hence, many have a strategy of regulatory compliance that can best be characterized as a combination of facial compliance (“We bought the manual and put it on the shelf”) and hope (“They’re not really serious about this, are they?”).  Unless you’re part of a practice of more than 20 doctors, it’s likely that you can do more to ensure regulatory compliance.

read more
adminWeave Compliance Into Your Practice For 2021

Attorney Zach Simpson Joins Florida Healthcare Law Firm in Delray Beach, Florida

by admin on July 1, 2020 No comments

Zach Simpson AttorneyFlorida Healthcare Law Firms adds experienced attorney Zach Simpson to the team to assist with pharmacy law, imaging center compliance, as well as chiropractic law, healthcare business development and contract negotiation.

Florida Healthcare Law Firm has announced that they have added Zach Simpson to the team. Zach brings a wealth of healthcare business experience in settings such as private medical practices, large law firms and healthcare management companies. Zach specializes in areas including operations, process, procedures, rules, regulations, management, organization, compliance, analytics, and problem solving. He’s also worked on physician dispensing programs and within numerous medical systems mastering programs like Abbadox, PACS, K-Pacs, Carestream, Merge, and Telax to improve the efficiency of medical centers’ day-to-day activities.

“Now more than ever, healthcare businesses are taking the time to attend to important tasks like processes, policies and procedures. The ones who unfortunately closed during COVID had some ‘downtime’ to focus on what to do better when reopening. Zach’s wide variety of experience in medical offices brings first hand knowledge on how to prepare and how to run things smoothly. As we all have adapted to a ‘new normal,’ Zach is on board to help with business management and development,” Florida Healthcare Law Firm COO Autumn Piccolo says. Founder and President, Jeff Cohen, goes on to say that, “We help you with the business operation side so that you can focus on what you do best, care for patients. Zach’s organizational skills and leadership are a great addition for current and future clients. His analytical and negotiation skills will absolutely benefit healthcare business owners.”

read more
adminAttorney Zach Simpson Joins Florida Healthcare Law Firm in Delray Beach, Florida

GDPR Compliance: Has Your Company Prepared for the Heightened Data Privacy Regulations?

by admin on June 6, 2018 No comments

“Protecting someone else’s data protects all of us.” Tim Cook, CEO of Apple

General Data Protection Regulation

By: Shobha Lizaso

We are in the age of electronic data and heightened data privacy. New laws to strengthen individuals’ privacy rights and to strengthen data protection are evolving worldwide. The General Data Protection Regulation (GDPR) establishes protections for the privacy and security of personal data about residents of the European Union. This new law affects US healthcare providers and organizations that provide services to residents of any of the EU countries, that collect data from EU residents or monitors EU residents through the use of cookies and the like, and practitioners involved in medical tourism programs and other clinical activities. GDPR imposes more restrictions on the collection, use, processing, storage, disclosure, and disposition of patient data than HIPAA.

GDPR became effective on May 25, 2018, and there will not be a compliance grace period, so healthcare providers should meet with their healthcare technology attorney to determine whether they are subject to the GDPR, to update their online Terms of Use & Privacy Policies, and to audit internal data handling procedures to prevent any violations.

read more
adminGDPR Compliance: Has Your Company Prepared for the Heightened Data Privacy Regulations?