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McBrayer Blogs
Showing 57 posts tagged Health Care Law.
Getting Long-Term Lost with Compliance for Long Term Care? OIG Has A Roadmap
Long Term Care (“LTC”) facilities have been a renewed area of focus for regulators in recent years, due to changes in Medicare and the potential for harm to a vulnerable population at the hands of bad actors. In April of 2019, for instance, the U.S. Department of Health & Human Services Office of Inspector General (“OIG”) put out a Data Brief with the ominous headline, “Trends in Deficiencies at Nursing Homes Show That Improvements Are Needed To Ensure the Health and Safety of Residents.” Unfortunately, this renewed focus exponentially increases the need for a push to instill compliance as a key tenet of a facility’s culture. Luckily, in 2000 and again in 2008, the OIG released a very clear roadmap for compliance that’s still reliable today. We’ll hit some of the highlights. More >
The Hard Truth: Treating the Opioid Epidemic Webinar Recap
Click here to watch the video replay of the webinar.
In January of 2019, the National Safety Council released a study with an alarming result: Since 2017, the odds of dying by accidental opioid overdose have exceeded the odds of dying in a car accident. With the opioid crisis raging, the first line of defense may now be healthcare providers, especially rural ones, who treat patients on a daily basis. More >
Healthcare Entities: How is Your Cyber Security?
In an evolving world of cyber terrorism where individuals such as Edward Snowden grab headlines by stealing national secrets, it should come as no surprise that protected healthcare information (“PHI”) kept by providers has become a “target rich environment” for foreign governments and individual hackers alike. In addition to threats from outside entities, healthcare providers must also realize and appreciate that state and federal regulatory and statutory requirements govern the creation, maintenance and protection of PHI, including through but not limited to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Health Information Technology for Economic and Clinical Health (“HITECH”) Act. Failure to abide by these complex and stringent rules can lead to significant penalties. More >
CMS Executes About-Face on Pre-Dispute Arbitration Ban
The Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule on June 5, 2017, that serves as an effective course reversal on pre-dispute arbitration agreements in a long-term care (“LTC”) setting. This caps off an effort by many in the healthcare and nursing home industry to stop the prior rule, which banned such agreements, from taking effect. More >
Compliance Programs for Nursing Facility Providers
Nursing facilities are now required to develop and implement effective compliance and ethics programs under newly-created Section 483.85 of the Affordable Care Act (“ACA”) §6102. These programs must be in effect by November 28, 2017. These regulatory requirements are highly complex, especially the requirement of annual review and revision of the programs. More >
Medicaid Expansion in Kentucky
The Supreme Court upheld much of President Obama’s Patient Protection and Affordable Care Act (“PPACA”) in National Federation of Independent Business et al v. Sebelius, but overturned a key element of PPACA’s Medicaid expansion provisions. Originally, PPACA required states to expand Medicaid coverage to individuals at or below 133 percent of the federal poverty level or risk forfeiting existing federal funding for the state’s Medicaid program. In National Federation, the Supreme Court held that PPACA could not withdraw existing Medicaid funding from states choosing not to expand their programs. This change presents each state with a meaningful choice to opt in or out of PPACA’s Medicaid expansion. More >
Senate Finance Committee Takes an In-Depth Look at Fraud & Abuse
Earlier this week, I discussed the HHS and DOJ Annual Report for the Health Care Fraud and Abuse Program. HHS and DOJ are not the only ones who are determined to purge the health care industry of its woes. On January 31, 2013 a group of six current and former members of the Senate Finance Committee released a comprehensive report detailing recommendations on combating waste, fraud and abuse in the Medicare and Medicaid Programs. More >
Annual Report Details Record Breaking Success in Health Care Fraud Prevention
The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), required the establishment of a national Health Care Fraud and Abuse Control Program (“HCFAC”). The HCFAC Program is a joint Department of Justice (“DOJ”) and Health and Human Services (“HHS”) coordination of federal, state and local law enforcement activities to combat fraud committed against all health plans, both public and private. More >
CMS 2014 Call Letter: A Bright Future for CMS Star Rating System
On February 15, the Centers for Medicare & Medicaid Services (CMS) issued the draft calendar year (CY) 2014 Call Letter for the Medicare Advantage (MA) and Part D programs (Call Letter). It contains information that MA organizations and Part D plan sponsors (collectively, Plan Sponsors) need to prepare their 2014 bids and operations. More >
CMS Proposes to Change Physician Requirements for RHC's and FQHC's
Since the passage of the Patient Protection and Affordable Care Act of 2010 (“PPACA”), many providers, suppliers and physicians that were enrolled in Medicare and Medicaid were mandated to create compliance programs for their healthcare facilities. Since that time, small and rural providers have been scrambling to adopt and implement programs that can adequately withstand regulatory and law enforcement scrutiny. Larger providers, such as multi-state hospitals, were already equipped with a compliance program. It is the small and rural providers, limited by staff and financial resources, which have had their hands full complying with the new regulatory requirements. More >
