Contact Us
Categories
- Coronavirus Aid, Relief and Economic Security Act
- Code Enforcement
- Department of Labor ("DOL")
- Employment Law
- FFCRA
- CARES Act
- Nursing Home Reform Act
- SB 150
- COVID-19
- Families First Coronavirus Response Act
- Family and Medical Leave Act (“FMLA”)
- KBML
- medication assisted therapy
- Acute Care Beds
- Clinical Support
- Coronavirus
- Emergency Medical Services
- Emergency Preparedness
- Department of Health and Human Services
- Legislative Developments
- Corporate
- United States Department of Justice ("DOJ")
- Employee Contracts
- Non-Compete Agreement
- Opioid Epidemic
- Sexual Harassment
- Health Resource and Services Administration
- Litigation
- Medical Malpractice
- House Bill 333
- Senate Bill 79
- locum tenens
- Senate Bill 4
- Physician Prescribing Authority
- HIPAA
- Chronic Pain Management
- Prescription Drugs
- "Two Midnights Rule"
- 340B Program
- Hospice
- Kentucky minimum wage
- Minimum wage
- Skilled Nursing Facilities (“SNFs”)
- Uncategorized
- EHR Systems
- ICD-10
- Primary Care Physicians ("PCPs")
- Electronic Health Records (“EHR")
- Drug Screening
- Mental Health Care
- Urinalysis
- Affordable Insurance Exchanges
- Fraud
- Health Care Fraud
- HIPAA Risk Assessment
- KASPER
- Office for Civil Rights ("OCR")
- Qui Tam
- Stark Laws
- Compliance
- Department of Health and Human Services (HHS)
- Kentucky Board of Medical Licensure
- Kentucky’s Department for Medicaid Services
- Office of Inspector General of the United States Department of Health and Human Services (OIG)
- Pharmacists
- Physician Assistants
- Accountable Care Organizations (“ACO”)
- Anti-Kickback Statute
- Centers for Medicare & Medicaid Services (“CMS”)
- Certificate of Need ("CON")
- Data Breach
- Electronic Protected Health Information (ePHI)
- False Claims Act
- Federally Qualified Health Centers (“FQHCs”)
- Fee for Service
- Health Information Technology for Economic and Clinical Health Act (HITECH Act)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- HPSA
- Medicaid
- Medicare
- Part D
- Patient Protection and Affordable Care Act (“ACA”)
- Rural Health Centers (“RHCs”)
- Telehealth
- Affordable Care Act
- Alternative Payment Models
- Charitable Hospitals
- Health Professional Shortage Area ("HPSA")
- Hospitals
- HRSA
- Limited Services Clinics
- Medical Staff By-Laws
- Medically Underserved Area ("MUA")
- Mid-Level Practitioners
- Rural Health Clinic
- Kentucky Board of Nursing
- American Telemedicine Association (“ATA”)
- Criminal Division of the Department of Justice (“DOJ”)
- Health Care Fraud Prevention and Enforcement Action Team (“HEAT”)
- Qualified Health Care Centers (“FQHC”)
- Telemedicine
- Hydrocodone
- Kentucky Pharmacists Association
- Webinar
- APRNs
- United States ex. Rel. Kane v. Continuum Health Partners
- Agreed Order
- Chain and Organization System (“PECOS”)
- Drug Enforcement Agency ("DEA")
- Jimmo v. Sebelius
- Maintenance Standard
- Overpayments
- Vitas Innovative Hospice Care
- Chiropractic services
- Clinical Laboratory Improvement Amendments of 1988 (“CLIA”)
- Douglas v. Independent Living Center of Southern California
- Emergency Rooms
- Enrollment
- Hinchy v. Walgreen Co.
- Kentucky Senate Bill 7
- Medicare Part D
- Minors
- Ophthalmological services
- Physician Compare website
- Re-validation
- Texting
- 2014 Medicare Physician Fee Schedule (“PFS”)
- All-Payer Claims Database ("APCD")
- Chronic Care Management
- Compliance Officer
- CPR
- Essential Health Benefits
- ICD-9
- Sustainable Growth Rate (“SGR”)
- 501(c)(3)
- Appeal
- Centers for Disease Control and Prevention
- Compounding
- Dispenser
- Drug Quality and Security Act (“DQSA”)
- Food and Drug Administratio
- HealthCare.gov
- House Bill 3204
- Kindred v. Cherolis
- Long-term care communities
- Mobile medical applications ("apps")
- National Drug Code ("NDC")
- National Institutes of Health
- New England Compounding Center ("NECC")
- Outsourcing facility
- Ping v. Beverly Enterprises
- Power of Attorney ("POA")
- Prescriber
- State Health Plan
- Affinity Health Plan
- Cadillac tax
- Community health needs assessment (“CHNA”)
- Condition of Participation ("CoP")
- Denied Claims
- Department of Medicaid Services’ (“DMS”)
- Federation of State Medical Boards (“FSMB”)
- Form 4720
- Grace Period
- Home Health Prospective Payment System
- Home Medical Equipment Providers
- Individual mandate
- Inpatient Care
- Kentucky Medical Practice Act
- Kynect
- Licensure Requirements
- Long-Term Care Providers ("LTC")
- Low-utilization payment adjustment ("LUPA")
- Medicare Shared Saving Program (MSSP)
- Model Policy for the Appropriate Use of Social Media and Social Networking in Medical Practice (“Model Policy”)
- Nonprofit hospitals
- Nonroutine medical supplies conversion factor (“NRS”)
- Personal Service Entities
- Physician Payments
- Qualified Health Plan ("QHP")
- Quality reporting
- Social Media
- Spousal coverage
- UPS
- “Superuser”
- "Plan of Correction"
- Arbitration
- Audit
- Daycare centers
- Decertification
- Division of Regulated Child Care
- EHR vendor
- Employer Mandate
- Fair Labor Standards Act (FLSA)
- False Billings
- Health Professional Shortage Areas (“HPSA”)
- Hospitalists
- Intermediate Sanctions Agreement
- Kentucky Health Benefit Exchange
- Licensed practical nurses (LPN)
- List of Excluded Individuals and Entities
- LLC v. Sutter
- Meaningful use incentives
- Medicare Administrative Coordinators
- Medicare Benefit Policy Manual
- Network provider agreement
- Nurse practitioners (NP)
- Office of the National Coordinator for Health Information Technology (“ONC”)
- Part A
- Part B
- Payors
- Physician Recruitment
- Physician shortages
- Provider Self Disclosure Protocol
- Registered nurses (RN)
- Residency Programs
- Self-Disclosure Protocol
- Statement of Deficiency ("SOD")
- Upcoding
- Advanced Practice Registered Nurses
- Business Associate Agreements
- Business Associates
- Call Coverage
- Doe v. Guthrie Clinic
- Employer Group Health Plans
- ERISA
- Group Purchasing Organizations ("GPO")
- Health Reform
- House Bill 104
- Kentucky House Bill 217
- Patient Autonomy
- Patient Privacy
- Personal Health Information
- Senate Bill 39
- Senate Finance Committee Report
- State Medicaid Expansion
- Trade Association Group Coverage
- Autism/ASD
- Genetic Information Nondiscrimination Act ("GINA")
- Kentucky House Bill 159
- Kentucky Primary Care Centers (“PCCs”)
- Managed Care Organizations (“MCOs”)
- Center for Disease Control
- Compliance Programs
- Critical Access Hospitals (“CAHs”)
- Essential Health Benefits (“EHBs”)
- Healthcare Information and Management Systems Society (HIMSS)
- Medicare Audit Improvement Act of 2012
- Occupational Safety and Health Administration (“OSHA”)
- Recovery Audit Contractors (“RAC”)
- Small Business Health Options Program (“SHOP”)
- Sunshine Act
- Abuse and Waste
- Consumer Operated and Oriented Plan programs (“CO-OPS”)
- Kentucky Cabinet for Health and Family Services
- Kentucky Health Care Co-Op
- Kentucky Health Cooperative (“KYHC”)
- Kentucky “Pill Mill Bill”
- Employee Agreement
- Free Conference Committee Report
- Health Care Fraud and Abuse Control Program
- House Bill 1
- House Bill 4
- Pain Management Facilities
- Health Insurance
- Healthcare Regulation
- Health Care Law
McBrayer Blogs
Compliance: Include Prescribing Practices!
Since the implementation of House Bill 1 in 2012, the restrictions on prescribing controlled substances have become more and more stringent, which is a response to the opioid epidemic sweeping Kentucky and the nation. The Cabinet for Health and Family Services, the Kentucky Board of Medical Licensure, the Kentucky Board of Nursing, and the Kentucky Board of Pharmacy are vigilant in policing prescribing practices and have tools through KASPER to closely monitor the prescribing practices of physicians and other practitioners. With the addition of new medications like Gabapentin to the controlled substances hit list, practitioners must be particularly careful to ensure that their prescribing is consistent with regulatory requirements, particularly when patients have been on this medication previously. Physicians and practitioners must continually monitor compliance as even a minor violation can give rise to investigations, complaints and regulatory penalties. Assessment of regulatory penalties, even when characterized as “Agreed Orders,” can have devastating consequences for physicians and practitioners’ practices and ability to maintain provider contracts, including Medicare and Medicaid.
The growing number of disciplinary actions by state licensure boards is evidence of the increasing scrutiny. HB 1 contains statutory directives to investigate and resolve through a complaint process on a strict time line. This can mean that documentation errors, even when there is the medical necessity for prescribing, may still create serious problems for physicians and practitioners. These often seem reasonable to resolve through Agreed Orders that require monitoring as well as education and training. These Agreed Orders, however, have serious ancillary effects on the ability to maintain provider status with Medicare and Medicaid, particularly as both programs embark on re-enrollment of all providers and the Agreed Orders are reportable to the National Practitioners Data Bank. In some cases, the illegal prescribing to Medicare patients as reported in licensing actions has the potential to create a situation where CMS may assess Civil Monetary Penalties and review exclusion of the provider. An Agreed Order should not be executed by a physician or practitioner without a careful examination of the potential effects.
The good news is that physicians and practitioners can prevent these issues by maintaining a vigilant compliance program. Prescribing practices should be an element of compliance and treated just as seriously as compliance efforts targeting fraud and abuse and false claims. Here, an ounce of prevention is worth a ton of cure.
Lisa English Hinkle is a Member of McBrayer law. Ms. Hinkle chairs the healthcare law practice and is located in the firm’s Lexington office. Contact Ms. Hinkle at lhinkle@mcbrayerfirm.com or (859) 231-8780, ext. 1256, or reach out to any of the attorneys at McBrayer.
Services may be performed by others.
This article does not constitute legal advice.