NPDB Guide for Reporting Clinical Privileges Actions
The National Practitioner Data Bank (NPDB) has published a quick guide to assist hospitals and health care entities in reporting actions that adversely affect clinical privileges held by physicians, dentists and other health professionals.
The guide (We have identified that the following link is no longer active, and it has been removed) lists several “reporting scenarios” and indicates the type of report that may be required (initial adverse action report, revision-to-action report, correction report, or no report). The guide also summarizes the reasons for voiding a previous report (report was erroneously submitted, action was not reportable, or action was reversed or overturned).
The guide is a helpful starting point for a hospital or health care entity that is involved in a privileging action. However, the scope and timing of reporting requirements under the NPDB regulations can be quite complex. Considering the very serious implications from reporting—or not reporting—an adverse privileging action, it would be prudent to only use the guide as a quick reference and not as a decision-making tool.
If you have any questions about the guide, please contact Richard Kraus at 517.371.8104 or by using the email form below.
Categories: Hospitals, Physicians
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Health Care Providers Face Steep Penalties for Medicare/Medicaid Fraud
So far, July has been a busy month for health care fraud enforcement across the country.
On July 18, Divyesh Patel, owner of Alpine Nursing Care Inc. in North Randall, Ohio, was sentenced to two years in prison after pleading guilty to one count of conspiracy to commit health care fraud and four counts of health care fraud. Patel was also ordered to pay total restitution of $1,939,864 to the Medicaid Program in Ohio. According to court documents, Patel hired Belita Mable Bush as the office manager despite knowing that Bush had been convicted of a health care-related felony and excluded from involvement in billing federal health care programs. From June 1, 2006 to October 18, 2009, Patel conspired with Bush to defraud Medicaid by billing for services that had never been performed or that had been performed by excluded individuals. The conspiracy resulted in losses of approximately $1.9 million to the Medicare and Medicaid programs. Bush was convicted on similar charges and will be sentenced next month. Read about more cases ›
Categories: Fraud & Abuse, Health Care Reform, Hospitals, Medicare/Medicaid, Physicians
Pioneer ACOs Find Blazing New Trails Isn't Always Easy
According to a recent Modern Healthcare article, up to 9 of the 32 Pioneer Accountable Care Organizations ("ACOs") may be leaving the program. Four have already notified providers of such withdrawal. Of the 9, 4 of the departing ACOs tentatively say they will be joining Medicare's lower- risk ACO alternative – the Medicare shared savings program. The deadline for deciding whether or not to remain in the Pioneer program is July 31, 2013. Read More ›
Categories: Accountable Care Organizations, Health Care Reform, Hospitals, Medicare/Medicaid, Physicians
Regulators Can Sue Over Pay-for-Delay Drug Settlements Between Brand Name and Generic Drug Makers
On June 17, 2013, the U.S. Supreme Court ruled that brand name drug makers can be sued for paying generic drug makers to delay the introduction of low-cost versions of popular medicines to the marketplace. The Court's 5-3 ruling is a victory for the Federal Trade Commission (“FTC”), and reverses a lower-court ruling that shielded drug makers from liability.
So-called "pay-for-delay" or reverse payment arrangements between brand name and generic drug makers result in payments being made to generic drug makers in order delay the launch of competing generic drugs. These settlements often stem from litigation, or threatened litigation, brought by brand name drug makers against generic drug makers who try to sell products prior to the patent expiration period. In this case, the FTC argued that pay-for-delay agreements cost consumers as much as $3.5 billion per year, while the pharmaceutical industry alleged that such deals are legitimate means of settling patent disputes. Read More ›
Categories: Pharmacy, Regulatory
New LARA Policy for Professional Services Corporations
The Michigan Department of Licensing and Regulatory Affairs (LARA) Corporations Division has recently implemented a new policy for professional service corporations requiring that the purpose clause in the articles of incorporation includes the type of license held. Previously, only the type of services provided was required.
For example, the purpose clause for a dental practice must now state that the purpose of the corporation is to provide "dental services through a licensed dentist."
This new policy is not stated in any of the LARA materials. However, Foster Swift attorneys and paralegals frequently work with LARA and can help streamline the creation of a professional services corporation by knowing these LARA policy insights.
If you have questions about the new policy or would like assistance with starting a professional services corporation, please contact an attorney at Foster Swift.
Julie C. LaVille authored this article as a Law Clerk.
Categories: Licensing, Physicians, Regulatory
Large Employers Rejoice! PPACA’s Employer Mandate Delayed until 2015
On July 2, 2013, the Obama administration declared that it was delaying the effective date of the Patient Protection and Affordable Care Act’s Employer Mandate until January 1, 2015. The Employer Mandate, which was scheduled to become effective on January 1, 2014, required all large employers to offer health care coverage to their full-time employees or pay a penalty. Most importantly, this delay means that the penalties to large employers for failure to provide health insurance coverage will not be enforced for another year. You may read the full statement issued by the U.S. Department of Treasury here. Read more about his announcement ›
Categories: Employment, Health Care Reform, Insurance
Medicaid Expansion Debate in Michigan Rages On
A key component of the Patient Protection and Affordable Care Act ("PPACA") involves expanding Medicaid to anyone who earns up to 133 percent of the poverty level. In its landmark ruling last year the Supreme Court, while upholding PPACA, ruled that states could not be compelled to expand the joint federal-state Medicaid program.
State legislatures and governors across the country have considered whether to expand Medicaid, with only 23 states and the District of Columbia implementing an expansion according to the (We have identified that the following link is no longer active, and it has been removed.) Under the PPACA, 100 percent of the cost of the Medicaid expansion will be covered by the federal government from 2014 through 2016. The federal government's contribution will gradually decline until reaching 90 percent in 2022 and beyond. What's happening in Michigan? ›
Categories: Health Care Reform, Insurance, Medicare/Medicaid, Regulatory
IRS Questioned by House Committee Following Alleged Seizure of Medical Records
On Tuesday, June 11, members of the House Committee on Energy and Commerce sent a letter to acting IRS Commissioner Daniel Werfel requesting information regarding how the IRS handles confidential medical information. The letter comes after a recent lawsuit alleging that the IRS illegally seized over 60 million medical records in 2011.
The lawsuit, a class action filed by an unnamed health care provider against 15 unnamed IRS agents, alleges that the agents improperly seized the medical records in violation of the Fourth Amendment during a search executed on March 11, 2011. According to the complaint, the agents seized more than ten million medical records despite knowing that the records were not within the scope of their warrant, (which authorized only the seizure of financial records related to a former employee). The seized records allegedly contained "intimate and private information . . . including psychological counseling, gynecological counseling, [and] sexual or drug treatment." The complaint further alleges that the agents threated to "rip out" the servers containing the medical data if the company's IT personnel did not voluntarily transfer the information to the IRS. Read More ›
Categories: Health Care Reform, HIPAA
Walgreens Agrees to Record $80 Million Settlement with DEA
On Tuesday, June 11, 2013, the Drug Enforcement Administration (“DEA”) announced that it had reached an $80 million civil settlement agreement, the largest in DEA history, with Walgreen Co. (“Walgreens”) to resolve allegations involving an “unprecedented number” of record-keeping and dispensing violations under the Controlled Substance Act (“CSA”). According to the DEA’s Press Release, Walgreens negligently allowed controlled substances, including Oxycodone and other prescription painkillers, to be diverted into the black market. Read More ›
Categories: Compliance, Fraud & Abuse, Hospitals, Pharmacy, Physicians, Regulatory
IRS Issues New Regulations Affecting the “Blues” Under Health Reform
The Treasury Department and IRS continue to roll out new regulations related to the implementation of the Patient Protection and Affordable Care Act ("PPACA"). On May 10, 2013, the Treasury Department and IRS released the draft regulations, "Computation of, and Rules Relating to, Medical Loss Ratio", which are intended to help Blue Cross and Blue Shield ("BCBS") organizations comply with the Medical Loss Ratio (“MLR”) rules created by the PPACA. Here's the background ›
Categories: Health Care Reform, Hospitals, Insurance, Physicians, Regulatory
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Best Lawyers® 2021
Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. Firm-wide, 44 lawyers were listed. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Health Care practice group members listed in Best Lawyers are as follows:
- Jennifer B. Van Regenmorter, Holland
To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.