November/December 2024 Issue
SUBSCRIBER CONTENT More providers are entering into agreements with referring physicians to provide consulting services to their organizations, but these legitimate relationships may easily be misunderstood by enforcers. To avoid potential violations, it’s crucial for providers to embrace seven practical guidelines.
The study identified six areas of possible change to the discharge planning process to reduce instances of unplanned hospital readmissions.
A watchdog organization filed a whistleblower lawsuit against MPI and the agencies it managed, resulting in a judgment of approximately $6 million.
July/August 2024 Issue
SUBSCRIBER CONTENT Noora Health’s Health Companion Program enhances family and caregiver knowledge, boosts professional development for aides, and gives your organization a competitive edge. Discover the key insights of this innovative program.
In this article is the legal case between referrals: assisted living, independent living facilities, and home health, details of the ruling, and what to consider in a referral relationship agreement.
May/June 2024 Issue
SUBSCRIBER CONTENT Personal care private duty agencies, it's crucial to recognize that fraud and abuse enforcement aren't exclusive to services covered by the Medicare Program. In fiscal year 2023 alone, there were 279 criminal convictions associated with private duty home care services. It's vital to understand the implications.
May/June 2024 Issue
SUBSCRIBER CONTENT CMS has unveiled the Direct Care Workforce Strategies Center, a pivotal initiative aimed at tackling the pressing shortage of workers providing direct care to elderly and disabled individuals. Worker registries play a crucial role in addressing fundamental questions: Who meets the criteria to deliver Home and Community-Based Services in each state, and how can Medicaid beneficiaries connect with them?
March/April 2024 Issue
SUBSCRIBER CONTENT Case managers or discharge planners found in violation of the anti-kickback statute may face criminal prosecution, potentially leading to prison sentences and other repercussions. If you were aware or should have been aware, you may bear responsibility. Attorney Elizabeth Hogue provides detailed explanations of these implications.
March/April 2024 Issue
SUBSCRIBER CONTENT Patients possess the right to select their care
providers, and this choice is reinforced through various avenues embedded in policies and regulations. Attorney Elizabeth Hogue explains the key touchpoints.
Discharge planners, case managers, and social workers certainly cannot accept cash payments from providers in exchange for referrals of patients. But what can they accept from providers who want referrals?
January/February 2024 Issue
SUBSCRIBER CONTENT The issues impacting prior authorizations from managed care organizations have caused some providers to discontinue relationships with plans. Starting January 1, 2024, UnitedHealthcare is changing home health agency processes.
November/December 2023 Issue
SUBSCRIBER CONTENT According to a recent analysis of Bureau of Labor Statistics data, home healthcare is one of the most dangerous places to work in healthcare. Homecare field staff members who provide services on behalf of private duty agencies, hospices, Medicare-certified home health agencies, and home medical equipment companies are extremely vulnerable.
September/October 2023 Issue
SUBSCRIBER CONTENT A Judge issued an opinion and order, in which he said that the State of Florida must provide services, including private duty nursing care, to medically fragile children who are living in nursing homes or threatened with institutionalization so that they can live at home.
September/October 2023 Issue
SUBSCRIBER CONTENT The study is based on eight focus groups that included nurses, physicians, discharge planning staff, and patients. It identified areas of possible change to the discharge planning process to reduce instances of unplanned hospital readmissions.
July/August 2023 Issue
SUBSCRIBER CONTENT A ruling from the Supreme Court may make it more difficult for enforcers to prove liability under the False Claims Act and more manageable for providers to defend themselves against claims of violations.
May/June 2023 Issue
SUBSCRIBER CONTENT Learn the results of a homecare agency’s audit and appeals case.
March/April 2023 Issue
SUBSCRIBER CONTENT Preferred-provider agreements are an important strategy for increasing referral relationships. This article provides a greater understanding of the legal aspects.
March/April 2023 Issue
SUBSCRIBER CONTENT Compliance with HIPAA can be complex. Examples of violations, or “HIPAA stories,” may make requirements more understandable. We share some of those stories.
A 1995 court decision involving Caremark established that members of boards of directors likely have liability for non-compliance with fraud and abuse prohibitions. A recent Court decision likely extends liability to individual corporate officers.
Compliance with HIPAA can be complex. Examples of violations, or “HIPAA stories,” may make requirements more understandable. Here are some of those stories.
“Poaching agreements” may produce artificial suppression of employees’ compensation and may violate the federal Sherman Act.
The Office of Inspector General has stated that there are two major types of fraud and abuse compliance that must be addressed through ongoing evaluation processes.
Practitioners owe a duty of care in the diagnosis and treatment of patients even though they are working under the supervision of licensed physicians.
Case managers/discharge planners continue to come under fire from fraud enforcers for violations of the federal anti-kickback statute.
It’s a new environment for anti-trust enforcement, especially in the healthcare industry. Providers should pay close attention to this issue.
To prove that providers rendered negligent wound care, patients must prove all of the following: Duty, breach, cause, and injury or damage.
Although the trend is certainly against non-compete agreements or restrictive covenants in the health care industry, some state courts have affirmed their use.
January/February 2022 Issue
FREE CONTENT Case managers/discharge planners continue to come under fire from fraud enforcers for violations of the federal anti-kickback statute.
The owner of a supplier of home medical equipment (HME) complained that her company did not receive referrals from TidalHealth Nanticoke Hospital. The Court dismissed the owner’s lawsuit because she could not prove her claims. This case illustrates why providers who complain about practices of referral sources must have facts to support their claims.
In a November 2021 decision, the U,S, Court of Appeals said that CMS can recoup overpayments from providers even though its appeals are still pending before Administrative Law Judges.
Providers, including marketers, are tempted to give patients free items and services. But be careful! These activities may violate laws prohibiting providers that participate in state and federal health programs from giving free items and services to patients.
November-December 2021 Issue
FREE CONTENT Effective on January 19, 2021, new regulations related to the Stark laws expanded and underscored the ability of hospitals to require physicians to send referrals to particular providers. These new regulations also make it clear that providers can monitor and enforce requirements to direct referrals to designated providers.
May/June 2021 Issue
The right of patients to choose providers has generated considerable conflict within the provider community. In this article, learn the four key legal sources supporting patient choice and actions your organizations and patients can take to have them enforced.
March/April 2021 Issue
Post-acute organizations need consulting physicians’ services. The OIG continues to scrutinize these relationships. What are the three things providers should know before signing agreements?
November-December 2020 Issue
In Advisory Opinion No. 18-05; issued on June 18, 2018; the OIG addressed the circumstances under which providers can establish “caregiver centers” that provide or arrange for free or reduced-cost support services to caregivers in local communities.
September/October 2020 Issue
How do anti-kickback statutes apply if providers or Assisted Living Facilities (ALFs) are involved in referral arrangements and receive any type of federal or state funds? Attorney Elizabeth Hogue breaks it all down.
Wound care is a risky business these days. Providers who render wound care services are at risk for many things, including liability for negligent wound care, violation of fraud and abuse prohibitions based on substandard wound care, and liability for abandonment when wound care services are discontinued.
The Centers for Medicare and Medicaid Services (CMS) has issued a number of waivers of various requirements for healthcare providers related to discharge planning for hospitals and critical access hospitals (CAHs).
May/June 2020 Issue
It’s an important time to review legal questions and issues related to COVID-19. There is a lot of mis-information flying around and it’s easy for providers to get tripped up. But providers must ensure that they are doing it right in order to avoid a day of legal reckoning that could threaten their businesses in the future.
Concern for healthcare workers in every setting knows no bounds! Providers' imperative is clear: everything possible must be done to keep them safe.
How can providers offer support for caregivers? A key way for providers to assist may be to collaborate with charitable organizations in the community.
Post-acute providers, patients, and their families have very successfully raised issues with hospital administrations related to patients' right to choose.
Recent federal cases make it quite clear that marketers for home health companies and discharge planners/case managers must just say, "NO!" The "jig is up."
Now is the time for all home care providers to review agreements and their practices with regard to payments to referring physicians.
The proposed rules recognize that incentives are different in a healthcare system that pays for value rather than the volume of services provided.
Why do providers continue to enter into business/referral relationships without meeting applicable requirements, thereby violating the law?
The OIG posted Advisory Opinion No. 10-03 on March 6, 2019, which permits hospitals to provide free, in-home follow up care to discharged patients.
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