Case managers/discharge planners continue to come under fire from fraud enforcers for violations of the federal anti-kickback statute.
About Elizabeth HogueElizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.
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.
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?
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?
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.