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McBrayer Blogs
Showing 65 posts tagged Health Care Law.
CMS Has Issued Proposed Rule Which Would Force Providers to Report Overpayments in 60 Days
The Centers for Medicare & Medicaid Services (“CMS”) released proposed regulations on Tuesday, February 14, 2012 proposing that providers and suppliers must report any self-identified overpayments within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due, whichever is the latter. More >
ON THE ENFORCEMENT RADAR: MEDICAID AUDITS AND THE 2012 OIG WORK PLAN
Unlike the Department of Health and Human Services Office of Inspector General (“OIG”) which publishes a Work Plan each year, the Department of Medicaid Services (“Medicaid”) generally does not publish guidance on the areas which it plans to investigate and/or audit. In fact, Medicaid’s website states … “Medicaid does not provide guidance on how companies should bill for services, but will direct you to applicable regulations. If you receive direction from staff about how to bill, the Department will not be bound by such instruction, unless it was given by a Director or Commissioner.” Because the federal integrity programs are now moving through the process, Kentucky Medicaid providers are starting to see lots of audit activities. Unlike the OIG audits, we don’t know the precise subject matter of the Medicaid audits, but the process for appeal is outlined below in addition to the areas announced for review by the OIG. More >
The Physician Employment Trend Continues
As healthcare reform continues to be implemented, the trend toward clinical integration and consolidation also continues and will be a defining characteristic of healthcare delivery in the years ahead. One critical component of clinical integration and consolidation has been health systems employing physicians to form large multi-specialty groups to serve the patient population. Physicians contemplating entering into an employment relationship with a hospital or health system must examine a number of critical issues before entering into an employment agreement. More >
ON THE ENFORCEMENT RADAR: THE 2012 OIG WORK PLAN
The Office of Inspector General of the United States Department of Health and Human Services (OIG) released its Work Plan for fiscal year 2012. At the beginning of each fiscal year, the OIG issues its annual Work Plan, which describes current audit, enforcement and evaluation activities and those the agency plans to initiate in the upcoming year. The Work Plan also provides a general view of the OIG’s investigative, enforcement and compliance activities. Basically, the Work Plan informs health care providers what is on the OIG’s enforcement radar in the coming year. Physicians should know what areas that the OIG is concerned about and review their own practices to ensure compliance with regulatory requirements. The following are some of the highlights from the FY 2012 Work Plan. More >
Courier Journal publishes online prescription database
The Courier Journal recently published an online database allowing the public to search, by prescriber last name or zip code, the number of prescriptions Kentucky doctors and other prescribers wrote between 2001 and 2011 for seven commonly-abused drugs: alprazolam, diazepam, morphine, methadone, fentanyl, oxycodone and hydrocodone. The newspaper accessed information from Kentucky’s Department for Medicaid Services via the Open Records Law, so the database is limited to Medicaid claims data. As Senator Grassley (R-IA) and other senators raise concerns that over-prescribing may constitute fraud and abuse, it is important for Kentucky physicians and prescribers to comply with compliance plans, state and federal laws, as well as Kentucky Board of Medical Licensure guidelines. More >
The Doctor’s Doctor: Professional Courtesy in an Age of Healthcare Regulation
For over 200 years, professional courtesy has been a hallmark of physician practice, a symbol of collegiality among doctors. Historians describe its 18th century beginnings as physicians providing charity care for the families of their deceased colleagues—an early form of health insurance for doctors’ widows and children. Over the years, the concept of collegial care also became the preferred alternative to physicians treating themselves or their own family members. In fact, the American Medical Association’s (“AMA”) first code of medical ethics created an obligation among doctors to reciprocate medical care and to extend the courtesy to physician family members as well. Today, the AMA recognizes professional courtesy as a “long-standing tradition” but not an ethical requirement.[1] The federal government’s commentary about “the provision of free or discounted health care items or services to a physician or his or her immediate family members or office staff,” however, is far more cautious than nostalgic. [2] The Department of Health and Human Services Office of Inspector General’s advice that physicians “consult with an attorney” before extending professional courtesy warns that certain arrangements for free or discounted medical care run afoul of fraud and abuse laws.[3] More >
Electronic Prescribing: A Medicare Cut is Looming for all Physicians in 2012 and 2013
Technology is wonderful! It seems like everyday our lives become easier and more convenient due to the ever changing world of IT. We can do almost anything over the Internet…order tickets, shop, chat, and now…even obtain prescription medications. More >
Accountable Care Organizations Regulations Passed This Week
The final rule for accountable care organizations (“ACO”s) released by the Obama Administration this week addresses many of the criticisms received by the proposed rule, which was published this spring. ACOs have been touted as one of the more promising initiatives of the Affordable Care Act because they aim to reduce the costs of caring for Medicare beneficiaries while improving quality of care by allowing provider partnerships to coordinate care, share medical records, and minimize duplicative tests and medical errors. More >
WHO IS THE DOCTOR ANYWAY?
As more nurses, pharmacists, physical therapists, chiropractors and other allied health professionals obtain advanced degrees that confer the ability to use the title “doctor,” physicians should be concerned that losing control over the term “doctor,” a word that has identified physicians for centuries, will create confusion for consumers and lead to a loss of control over the practice of medicine. With a shortage of physicians nationally as well as in Kentucky, mid-level practitioners are becoming the gatekeepers for health care. Mid-level practitioners now make important medical decisions about diagnosis and access to care. In Kentucky, the Kentucky Board of Medical Licensure (“KBML”) has taken an active role regulating the practice of certain allied health professions. Professions that have their own licensing authority, however, have the ability to broaden the scope of practice of their profession and determine what title may be used. The tensions between the professions may culminate in who gets to use the term “doctor.” More >
HEALTH LAW POTPOURRI: ESSENTIAL INGREDIENTS
With an economy in recession and health care costs that continue to rise, attorneys are bound to represent physicians, hospitals, nursing homes, physical therapists, chiropractors, nurse practitioners and many other types of health care providers as well as their patients at some time. The current complexity and uncertainty of health law and its regulations are recipes for confusion for all lawyers even those that practice in the health law area on a daily basis. The following represents a potpourri of health law topics that are important areas for attorneys to know about regardless of practice area. More >
