Showing 52 posts by Jennifer B. Van Regenmorter.
CMS Proposed Rule Affecting Home Health Agencies
The Centers for Medicare & Medicaid Services ("CMS") recently
announced proposed changes to the Medicare home health prospective payment
system (“PPS”) for the 2015 calendar year. CMS is proposing to tighten eligibility
requirements for home health services
and set a minimum requirement on Home Health Agencies ("HHAs") to
prove their effectiveness, as well as revise how much CMS will pay for certain
services. These proposed changes are expected to reduce Medicare payments to
HHAs by $58 million next year alone, a reduction of .30 percent.
To qualify for the Medicare home health benefit, a beneficiary must be under the care of a physician, have a need for skilled nursing care, physical therapy, speech-language pathology, or continued need for occupational therapy. Further, the beneficiary must be homebound and receive home health services from a Medicare approved agency.
The proposed changes include the following: Read More ›
Categories: Health Care Reform, Medicare/Medicaid
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OIG Issues Special Fraud Alert on Clinical Laboratory Payments to Physicians
The Office of the Inspector General for the United States Department of Health and Human Services (the “OIG”) recently issued a Special Fraud Alert regarding laboratory payments to referring physicians (the “Alert”). The Alert relates to two types of compensation arrangements - Specimen Processing Arrangements and Registry Arrangements - between clinical laboratories and physicians who order clinical laboratory tests that the OIG believes present a substantial risk of fraud and abuse under the federal anti-kickback statute. Read More ›
Categories: Compliance, Fraud & Abuse, Physicians
Planning for CHOWs of Home Health Agencies and the 36-Month Rule
Due to regulatory and reimbursement constraints, health care providers are increasingly merging, affiliating, and acquiring other health care entities. In these transactions, the Medicare providers must identify whether a Medicare change of ownership (“CHOW”) will occur. Although it may appear, from a business standpoint, that a change of ownership will occur, the transaction may not necessarily be considered a CHOW for Medicare. Essentially, if the person or entity with ultimate responsibility for the provider changes, typically there will be a Medicare CHOW. Sometimes, but not always, this will be indicated by whether there has been a change in the taxpayer identification number.
CHOWs impact the Medicare provider agreement involved in the sale. Unless the buyer takes steps to affirmatively reject the seller's provider agreement, in a Medicare CHOW, the seller's provider agreement is automatically assigned to the buyer. This provides billing advantages for the buyer without having to enroll as a new Medicare provider, go through the initial enrollment process, and be re-surveyed or re-accredited, which takes several months. Read More ›
Categories: Compliance, Medicare/Medicaid, Providers
Cracking Down on Fraud and Waste: OIG Releases Recommendations to Increase HHS Program Efficiency
In March of 2014, the Office of the Inspector General ("OIG") released the "OIG Compendium of Priority Recommendations." The recommendations offered are designed to help current programs for the Department of Health and Human Services ("HHS") run more effectively. The recommendation discussed twenty-five "opportunities" which, if addressed, would help to eliminate fraud and waste among HHS programs. The “opportunities” include the following: Read More ›
Categories: Compliance, Fraud & Abuse, Medicare/Medicaid, Providers
New Laws Expand Powers and Responsibilities of Guardians Relating to DNR Orders
On Feb. 4, 2014, new legislation took effect amending Michigan's Do-Not-Resuscitate Procedure Act (the "Act").The Act allows a guardian, who has the power under Michigan’s guardianship laws, to consent to a do-not-resuscitate order (“DNR Order”) on behalf of a legally incapacitated person under certain conditions. This power does not extend to a guardian ad litem.
In 1996, Michigan passed the Act, which permits a competent adult or his or her patient advocate to sign a DNR Order instructing emergency personnel not to perform potentially life-saving procedures in the event of the cessation of respiration and circulation. However, the Act did not give express authority to a guardian acting on behalf of an individual to authorize a DNR Order. Read More ›
Categories: Compliance, Hospitals
Omnicare Settles Whistleblower Lawsuit Alleging Kickback Scheme With Nursing Homes
Omnicare Inc., the nation's largest dispenser of prescription drugs in nursing homes, announced on October 23, 2013, that it has agreed to pay $120 million to settle a whistleblower lawsuit alleging kickbacks to nursing homes.
The whistleblower in the case, an Ohio pharmacist named Donald Gale, worked for Omnicare from 1993 until 2010. The lawsuit, filed in federal court in Cleveland in 2010, accused Omnicare of giving discounts for prescription drugs to nursing homes for certain Medicare patients in return for referrals of other patients at higher prices paid for by the federal government. Read More ›
Categories: Billing/Payment, Fraud & Abuse, Medicare/Medicaid, Pharmacy, Providers
Recap From the 2013 Health Law Institute
On March 7 and 8, 2013, the members of Foster Swift’s Health Care Law Group attended the 19th Annual Health Law Institute. This two-day institute, which is co-sponsored by the Institute for Continuing Legal Education and the Health Care Law Section of the State Bar of Michigan, focused on recent legal developments in health care law. Specific topics addressed at this year’s Health Law Institute included: Read More ›
Categories: Health Care Reform, Health Insurance Exchange, HIPAA, Hospitals, Insurance, Physicians, Regulatory
Health Care Fraud and Abuse Enforcement - It's Not Just Hypothetical Anymore
On February 11, 2013, the Departments of Justice and Health and Human Services jointly released a report stating that the government recovered $4.2 billion in fiscal year 2012 and for every dollar spent on health care-related fraud and abuse investigations in the last three years, the government recovered $7.90. The report indicates that this is the highest 3-year average return on investment in the 16 year history of the Health Care Fraud and Abuse program. The Health Care Fraud Prevention and Enforcement Action Team (“HEAT”), which has operations in Detroit, was instrumental in this recovery effort. Read More ›
Categories: Fraud & Abuse, Health Care Reform
IRS Focusing on Employment Tax Compliance
Recently, health care organizations have been inquiring about employment tax issues, and more specifically, the proper tax classification of their workers. Questions include whether to classify medical directors, such as hospice medical directors, as employees versus independent contractors. Read More ›
Categories: Employment, Tax
Hot Off the Presses: Foster Swift Health Care Law Newsletter
The latest edition of the Foster Swift Health Care Law Newsletter has just been released. Topics include Electronic Health Records, Medicare Reimbursement for Resident Research and Hospital Community Needs Assessments. In order to whet your appetite, below is a brief summary of the articles: Read More ›
Categories: Billing/Payment, Electronic Health Records, Health Care Reform, Health Insurance Exchange, HITECH Act, Hospitals, Medicare/Medicaid, Physicians
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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.