A Summary of the New Antikickback Safe Harbors and Stark Law Exceptions
On December 2, 2020, HHS published two final rules including important changes to the AKS and Stark Law regulations. OIG, responsible for enforcing AKS, issued a final rule addressing changes to the AKS and revisions to Civil Monitory Penalty rules regarding Beneficiary Inducement. CMS, responsible for enforcing the Stark Law, issued the final rule addressing changes to the Stark Law.
CMS PROPOSES MEDICARE PART B TO COVER ALL CGMs
Medicare Part B does not cover payment for purchase/rental and supplies/accessories of non-therapeutic continuous glucose monitors (CGMs). In a Proposed Rule, dated November 4, 2020, CMS has proposed to reclassify all non-therapeutic CGMs as DME, thus, qualified for Medicare Part B benefit payment.
2021 EXPANSION OF TELEHEALTH SERVICE COVERAGE BY CMS
On August 3, 2020, the Center for Medicare and Medicaid published its Proposed Rules for Medicare Physician Fee Schedule (PFS) for Calendar Year 2021. Public Comment period on the Proposed Rule ended on October 5, 2020. In the Proposed Rule, CMS proposed to add several telehealth services to its coverage on a permanent basis for 2021.
Do I Need a Healthcare Attorney?
If you conduct business in healthcare, you should consider engaging a healthcare attorney to assist you with your legal questions. Entities such as hospitals, laboratories, home health agencies, nursing facilities, physician organizations, dentist practices, chiropractors, pharmacies, etc. that transact healthcare business, will at some point require consultation of a healthcare attorney.
5 OSHA RECOMMENATIONS TO CONSIDER WHEN DOING BUSINESS DURING THE COVID-19 PANDEMIC
Employers are required to maintain a safe workplace for their employees. Federal Occupational Safety and Health Act (OSHA) and its related regulations comprise a body of law that impacts workplace safety. This article discusses 5 requirements and recommendations from federal OSHA and its related regulations that employers should consider during the COVID-19 pandemic.
TELEMEDICINE IN THE TIME OF COVID-19
With an increase in telemedicine usage, there is also concern and opportunities for fraud. Many factors contribute to fraud in telemedicine, such as a lack of baseline model for the types, charges, frequency of claims generally involving telehealth, identity theft, and prescribing medically unnecessary drugs and DME.
EMERGENCY WAIVERS TO FEDERAL SELF-REFERRAL LAW
Now that health care facilities are fully reopening in many states, it is an appropriate time to review the federal health care regulatory blanket waivers of Section 1877(g) (Self-Referral Law). These blanket waivers were designed to make it easier for health care industry to function in this emergency. Department of Health and Human Services (HSS) implemented these blanket waivers in response to the COVID-19 pandemic.
HEALTH CARE PROVIDER RELIEF FUND – Additional COVID Aid to Eligible Health Care Providers
Beginning on April 10, 2020, eligible health care providers will automatically receive additional COVID aid from the Department of Health & Human Services. HHS is distributing $30 billion by directly depositing funds into bank accounts of eligible health care providers. Although this initial $30 billion distribution is in form of a payment and does not have to be paid back, the payment comes with certain obligations and conditions which should be considered prior to acceptance. Below are responses to common questions about these aid payments.
Peer-Review: Five Important Considerations for the Medical Staff
Credentialing is serious business. Hospitals must constantly enforce their policies, assess risk and review standard of care to stave off liability and ensure quality of care. When a hospital determines that conduct of a staff physician rises to a risky level, it refers that member to peer-review for further investigation and corrective actions.
Mobile Devices, HIPAA Compliance & Risk Analysis
Mobile devices, including cell phones, tablets, and laptops increase the risk associated with breach of electronic Protected Health Information (ePHI). Entities regulated by HIPAA Privacy, Security and Breach Notification Rules should consider including mobile devices in their HIPAA risk analysis and take steps to reduce risks identified with the use of mobile devices.
Cyber Security – The New Data Breach Frontline
Cyber security is the new frontline of a data breach. Increased use of internet, cloud storages and technology in the medical field makes the industry susceptible to data breach. A study released by the U.S. State and Federal Government Cybersecurity in 2017, has identified the healthcare industry among the most vulnerable to cyber-attack, ranking it below food industries and retail.
OIG Identified Five Characteristics Signaling Fraud, Waste and Abuse by Home Health Agencies
Between 2011-2015, Office of Inspector General investigations have resulted in more than 350 criminal and civil actions and $975 million in receivables. The OIG and Government Accountability Office have raised concern about questionable billing patterns, compliance problems, and improper payments in home health. In the course of their investigations, OIG has identified over $10 billion in improper payments in FY 2015.
The Effects of Obama Care on US Permanent Residents (Green Card Holders)
In 2010, after decades of debate and lagging behind many other developed nations, the United States passed a comprehensive healthcare act named the Affordable Care Act of 2010 (a.k.a., Obama Care). Despite all the legislative issues, legal challenges and political attacks on this law, Obama Care is here to stay and we should begin thinking about how it affects our everyday lives and how to comply with its requirements.
The Stark Law and the “Group Practice” Requirement
The Stark Law is primarily set forth in section 1877 of the Omnibus Budget Reconciliation Act of 1989 (OBRA 1989). This law prohibits physicians from referring Medicare patients to an entity for designated health services (DHS), if the physician or the physician’s immediate family has a financial relationship with the entity.