It’s no secret that the Department of Justice has made the False Claims Act (“FCA”) a priority for years. Last month, we discussed why regulatory changes in response to Covid-19 (e.g., STARK waivers) could provide additional bases for the government to bring FCA cases. This post addresses the basics of cooperation credit for defendants who cooperate with the Department of Justice during an FCA investigation.
On October 23, Shareholder Corinne Smith will moderate a coding webinar titled, “Changes to Outpatient Evaluation and Management (E/M) Guidelines,” which will cover the significant changes to outpatient E/M services that will go into effect on January 1, 2021. The webinar will also discuss best practices and elaborate on information that is critical for healthcare attorneys, accountants and medical professionals to understand as they navigate healthcare compliance issues, false claims and reimbursements.
This webinar is approved for CPE and CLE credits.
Corinne Smith, Shareholder, Winstead
Jeannie Cagle, Senior Manager, Coker Group
Rosalind Cordini, Senior Vice President/Director of Coding & Compliance Services, Coker Group)
Register here: https://bit.ly/3lUuRfZ
The U.S. Department of Health and Human Services (HHS) recently finalized transformative rules that will give patients unprecedented safe, secure access to their health data. The rules are issued by the HHS Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS) to implement interoperability and patient access provisions of the bipartisan 21st Century Cures Act (Cures Act). These final rules mark the most extensive healthcare data sharing policies the federal government has implemented, requiring both public and private entities to share health information between patients and other parties while keeping that information private and secure. These final rules became effective as of June 30, 2020. NOTE: Due to the COVID-19 public health emergency, HHS has delayed enforcement until future dates. Continue Reading How HHS Information Blocking Regulations Apply to Healthcare Providers
Regulatory developments—such as the Stark Law blanket waivers and the OIG’s enforcement deferral for use of the waivers—have helped healthcare providers during the COVID-19 crisis, but healthcare fraud remains a prime target of the DOJ and the OIG (in addition to state regulators). Between October 2018 and September 2019, the DOJ obtained over $3 billion in judgments and settlements from fraud claims, a substantial portion of those claims relating to healthcare fraud. The significant increase in qui tam litigation since the 1980s is also notable. So what fraud and abuse actions could regulators pursue in COVID-19’s shadow? Continue Reading Do Covid-19 Regulatory Changes Pose an Increased Risk of Fraud and Abuse Liability for Healthcare Providers?
Among the multitude of relief options under the CARES Act, the U.S. Department of Health & Human Services (HHS) allocated provider relief funds (PRF) to healthcare providers. Phase I in late April saw healthcare providers receive $50 billion in general PRF distributions, largely based on historical Medicare volume or net revenues. Phase II followed in early May with general PRF distributions of $15 billion for Medicaid, Children’s Health Insurance Program (CHIP), and dental providers. And continuing after that, HHS issued some $52 billion in targeted PRF distributions among: (1) hospitals treating large numbers of COVID-19 patients; (2) rural providers; (3) skilled nursing facilities; (4) safety net hospitals; and (5) tribal healthcare providers. All in all, HHS issued $175 billion in PRF to support healthcare providers.
On August 4, 2020, the Office of Inspector General of Health & Human Services (OIG) used a new website resource to share informal guidance on the ability of laboratories to provide free COVID-19 antibody testing to Medicare beneficiaries. For the specific situation, the requestors indicated that the clinical lab would provide free COVID-19 antibody testing to patients—including federal healthcare program beneficiaries—in conjunction with other medically necessary blood tests performed by the lab. The lab indicated that it would not charge any patient or other payors for the COVID-19 antibody tests offered in conjunction with other paid lab tests. The requestors also indicated that the purpose of the arrangement had a public health focus as it was intended to increase patient awareness of antibodies to promote donations of COVID-19 blood plasma, which can be used for certain experimental convalescent plasma therapy treatments for COVID-19.
On June 30, 2020, Winstead PC attorney Sarah Churchill Llamas participated in a panel discussion—How to Increase Enterprise UX?—as part of the UX & Telehealth RapidConf. Discussions centered on telehealth and its overall market-effect in the rapidly evolving healthcare landscape. The panel was hosted by Fabien Beckers (Arterys), and included other panelists such as Laura Berrara (ECG Management), John Fryer (Lumeris), and Balint Bene (bene : studio). Here are a few key takeaways from the discussion:
It is difficult to identify any aspect of everyday life that the global COVID-19 pandemic has not, in some way, impacted or altered. As the healthcare community valiantly responds and adjusts to the myriad challenges associated with the novel coronavirus, individual patients have also been forced to rearrange in the midst of the public health crisis. For healthcare providers and patients, COVID-19 has upended many aspects of life that not long ago seemed rather stable and relatively predictable, such as education, travel, employment, entertainment, shopping, finances and social gatherings. A disruption of this magnitude has spurred innovation in the delivery of medical care. At the same time, providers should be mindful of recent studies indicating nearly half (45%) of adult Americans report having their mental health negatively impacted due to COVID-19, demonstrating an increase in the need for behavioral and mental health treatment and services during the public health crisis.