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Health Care

  • Setting Up Your Compliance Internal Reporting Mechanism

    Posted on March 3, 2017, Authored by John H. Fisher, II, Filed under Health Care

    One of the primary elements in a Compliance Program is the creation of a system that permits employees and others to provide information regarding potential compliance issues without fear of retaliation.  In larger organizations, multiple pathways permitting employees to make anonymous complaints should be maintained.  Oftentimes providers use 24…   

  • Recent Changes to Medicare “Incident To” Billing Rules

    Posted on March 2, 2017, Authored by John H. Fisher, II, Filed under Health Care

    Medicare permits a physician to bill for certain services furnished by a nurse practitioner or other auxiliary personnel under what is referred to as the "incident to" billing rules.  The "incident to" rules permit services or supplies furnished as an integral, although incidental, part of the physician's personal professional services in the cours…   

  • The Case of the Very Very Impossibly Long, Terrible, Horrible, No Good, Very Bad Day

    Posted on February 28, 2017, Authored by John H. Fisher, II, Filed under Health Care

    How Fraud and Abuse Cases Arise in a Medical Practice It is no secret many doctors work very long days.  Some days are worse and some are better than others.  As a compliance lawyer, my job is to attempt to prevent doctors from having Terrible, Horrible, No Good, Very Bad Days.  In my experience, this type of day happens when the Office of Inspect…   

  • Chiropractic Service Overpayment for Lack of Medical Necessity

    Posted on February 27, 2017, Authored by John H. Fisher, II, Filed under Health Care

    Recent OIG Release Emphasizes Need for Compliance Policies Specific to Provider Risks The Office of Inspector General recently published results of its audit of Medicare claims for chiropractic services made by a chiropractic group in Kansas.  The review concluded the groups received over $725,000.00 in overpayments in calendar years 2011 and 2012…   

  • Department of Justice Issues Principles of an Effective Compliance Program

    Posted on February 24, 2017, Authored by John H. Fisher, II, Filed under Health Care

    The Department of Justice issued a directive entitled “Evaluation of Corporate Compliance Programs.”  The document provides insight into the analysis used by the DOJ to assess the effectiveness of a corporate compliance program when making sentencing recommendations under the United States Sentencing Guidelines. The document references the Princip…   

  • House Republicans and Trump Administration File Joint Motion to Delay Suit Challenging Obamacare Subsidies

    Posted on February 23, 2017, Authored by John H. Fisher, II, Filed under Health Care

    An interesting development transpired Tuesday, February 21, 2017 in a case pending in Federal District Court in the District of Columbia that challenges subsidy payments from the Federal Treasury to support Obamacare.  The case was originally filed by House Republicans in 2014 challenging the constitutionality of the Obama administration’s authoriz…   

  • CMS Recommendations Regarding Protection from Cybersecurity Risks

    Posted on February 22, 2017, Authored by John H. Fisher, II, Filed under Health Care

    On January 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued Recommendations to Providers Regarding Cyber Security.  In general, the Recommendations are intended to remind providers and suppliers to keep current with best practices regarding mitigation of cybersecurity attacks.  The Recommendations contain an interesting discu…   

  • Atlanta Dentist Goes to Jail for Medicaid Fraud - Do You Hear Me Now on Dental Practice Compliance?

    Posted on February 21, 2017, Authored by John H. Fisher, II, Filed under Health Care

    A few months ago, the Atlanta Journal-Constitution reported on the guilty plea of an Atlanta dentist for Medicaid fraud.  Just this week, the dentist was sentenced to serve a year and a half in federal prison. The dentist was alleged to have netted around $1 million in fraudulently obtained reimbursement from the Medicaid program.  As part of her …   

  • CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018

    Posted on February 17, 2017, Authored by John H. Fisher, II, Filed under Health Care

    On February 17, 2017, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule aimed at reforming and stabilizing the individual and small group health insurance markets. When (or if) finalized, the proposed rule would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, net…   

  • Confidentiality of Alcohol and Drug Abuse Patient Records - Final Rule Revising Regulations

    Posted on February 17, 2017, Authored by John H. Fisher, II, Filed under Health Care

    The Department of Health and Human Services (HHS) has released a final rule to update and modernize the Confidentiality of Alcohol and Drug Abuse Patient Records regulations effective February 17, 2017. The new regulations contain special confidentiality restrictions relating to information pertaining to patients receiving treatment for a substanc…   

  • Home Health Agency Final Conditions of Participation Revisions Released by CMS

    Posted on February 14, 2017, Authored by John H. Fisher, II, Filed under Health Care

    The Center for Medicare and Medicaid Services has issued a final rule that revises and modernizes the Conditions of Participation (COP) for Home Health Agencies.  The Final Rule can be found in its entirety at: Final Home Health Rule (CMS-3819-F). The new Rule describes the conditions Home Health Agencies (HHA) must meet in order to participate in…   

  • Wisconsin DHS Prohibits Maneuvers and Techniques in Community Based Programs

    Posted on February 10, 2017, Authored by John H. Fisher, II, Filed under Health Care

    The Wisconsin Department of Health Services (DHS) released a memo specifying maneuvers or techniques that may not be used at any time in community based programs and facilities. DHS deems the prohibited maneuvers or techniques to "present an inherently high risk of serious injury and even death."  Providers are directed by DHS to immediately discon…   

  • Compliance Officer and Legal Counsel Relationships

    Posted on February 9, 2017, Authored by John H. Fisher, II, Filed under Health Care

    I am often asked my opinion whether a general counsel can also serve in the role of compliance officer.  At first blush, it seems the general counsel would be a perfect fit for the role because of general knowledge of regulations applicable to the organization.  Clients are often surprised when I tell them it is not appropriate to assign the compli…   

  • OIG Report Indicates Areas of Hospice Fraud Vulnerability and Issues a Warning to Hospice Providers

    Posted on January 27, 2017, Authored by John H. Fisher, II, Filed under Health Care

    The HHS Office of Inspector General recently released a report indicating deficiencies in hospice election statements and physician certification of patient eligibility for hospice care.  Medicare hospice care provides help to patients who are terminally ill continue life with minimal disruptions.  In order to qualify for hospice benefits, a physic…   

  • Lessons Learned from Recent OCR Settlements

    Posted on January 26, 2017, Authored by John H. Fisher, II, Filed under Health Care

    We can learn some valuable lessons about compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) from settlements that are announced by the U.S. Department of Health and Human Services, Office for Civil Rights (OCR).  These settlements give us guidance of issues OCR considered important as well as their interpretatio…