Healthcare Law Blog

OIG, in a Departure, Approves Hospital Provision of Nurse Practitioner Services

Traditionally, the Office of the Inspector General for the U.S. Department of Health and Human Services (“OIG”) would take a hard stance on any arrangements that might involve some form of remuneration from a hospital to a referring physician, but the winds of change may be blowing. In Advisory Opinion 22-20, published in December of 2022, the OIG has given a green light, albeit in a limited context, to an arrangement in which a hospital may have its employee nurse practitioners perform some services traditionally performed by the patients’ primary care physicians. This is a small step in the direction of a more flexible OIG stance on the federal Anti-Kickback Statute (“AKS”), but it doesn’t completely sidestep risks. More >

Fine Lines in Medical Spa Regulations

Medical spas (also known as ‘medspas,’ ‘medispas,’ or ‘esthetic salons’) combine advanced medical esthetic services that would have previously only been found at plastic surgery clinics or dermatologists’ offices (such as Botox injections, laser hair removal, chemical peels, injectable fillers, and acne treatments) with those found in a traditional day spa. Often, these procedures require the supervision of a licensed physician or nurse practitioner, creating a unique regulatory issue. As medspas have generated billions in revenue annually across the country and involve several types of healthcare and cosmetology professionals, it is critical for healthcare professionals offering services at a medspa to understand their specific obligations to maintain compliance with the law and prioritize patient safety. More >

Malnutrition Diagnosis Codes: The Compliance Danger You’re Not Taking Seriously Enough

It may seem like hair-splitting, but including the wrong diagnostic codes for malnutrition on hospital inpatient claims – using codes for severe malnutrition in place of other forms of malnutrition – is a costly mistake. The estimated overpayment as a result of these coding errors is a reported $1 billion. Because the payment error rate was so high at a colossal 31%, Medicare-Severity Diagnosis Related Group ("MS-DRG") applicable entities must take note and prepare for a marked increase in Department of Health and Human Services Office of Inspector General ("OIG") audits for these coding practices. The Centers for Medicare & Medicaid Services ("CMS") also plans to implement review practices for malnutrition coding on a sample of inpatient claims. The increased payer audits will result in severe financial damage for hospitals and other MS-DRG applicable entities if they do not mitigate coding and documentation risks. More >

Companies—It May Be Time to Reevaluate Your Corporate Compliance Program

In April 2019, the United States Department of Justice (“DOJ”), Criminal Division, issued a guidance document entitled “Evaluation of Corporate Compliance Programs.”[1] This guidance updates standards the DOJ utilizes to investigate, charge, and negotiate criminal charges related to corporate crimes.[2] Although the DOJ recognizes that each company has its own set of unique risks, its investigations often include three common questions in assessing the effectiveness of a company’s corporate compliance program. More >

A Physician’s Guide to Employment Contracts with Hospitals and Health Systems

As hospitals and health systems continue moves toward clinical integration, more physicians are being employed by hospitals and health systems rather than practicing medicine in their own private practices.  The trend toward direct hospital employment of physicians accelerated after 2012 and it appears that the trend will continue as both hospitals and physicians navigate regulatory, reimbursement, and operational challenges in the future.  When considering employment by a hospital or health system, physicians should be mindful of various provisions that are often contained in physician employment agreements and how these provisions may impact the physician’s professional practice and personal life.  Here are important issues to consider when evaluating whether to enter into an employment agreement with a hospital or health system.  More >

A New Opportunity: Centers for Medicare and Medicaid Services Recognizes the Full Potential of Ambulance Crews and Services

In mid-February 2019, the Centers for Medicare and Medicaid Services (“CMS”), Innovation Center and the Department for Health and Human Services (“HHS”) announced a ground-breaking payment and medical services initiative for ambulance providers called “Emergency Triage, Treat and Transport” (the “ET3”). This new model is the first step in allowing providers of Emergency Medical Services to finally “take off the gloves” to fully utilize both their medical skills and unique patient knowledge to implement a more efficient and effective care model. More >

Compliance is Crucial

This article appeared in the December edition of MD-UPDATE, available at  http://www.md-update.com/wp-content/uploads/2018/12/MD-Update-Issue-118/#?page=8

In the current legal enforcement environment, it is crucial that healthcare providers prioritize compliance initiatives and programs in order to avoid illegal practices that may result in large financial penalties and both criminal and civil liability.   More >

Healthcare Practitioners – Three Ways to Use KASPER to Protect Your Practice

Prevention and compliance best practices for healthcare providers are a hot topic, and this isn’t likely to change, maybe ever. As the opioid crisis continues to grow and healthcare providers come under increasing scrutiny, one tool is emerging as a resource for prescribing providers, and it’s probably not what you would expect: KASPER, Kentucky’s prescription reporting database. Below are three ways to get the most out of KASPER to keep your practice in compliance. More >

With Great Power, Comes Great Liability?

As medical advancements and patients in need of medical care continue to increase, the role of mid-level practitioners becomes even more crucial.  While there have been many turns of phrase for these medical professionals, the term “mid-level practitioner” is meant to encompass those non-physician providers, which include advanced practice nurses and physician assistants, among others. In Kentucky, there has been a shortage of primary care providers, which is particularly problematic in the state’s many rural areas.  This in turn has led to the push for more autonomy to these integral medical providers. While there are many reasons why this development is an improvement for patients and providers alike, this also leads to more liability exposure.  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 >