The OIG added four items to its Work Plan with the November 2017 update, as listed on the chart below. Interestingly, three of the four new items relate to Medicaid. Hot topics include prescriptions for extreme amounts of opioids and Medicaid’s use of telemedicine. Hospitals will want to know that the OIG is looking into hospital inpatient billing for severe malnutrition. Below are brief descriptions of the four new items.
Following a trend from the previous two Work Plan updates and consistent with the government’s growing focus on the opioid crisis, the OIG will be examining prescriptions for extreme amounts of opioids to Medicaid beneficiaries. The OIG observes that Medicaid beneficiaries, particularly those on disability, are more susceptible to opioid abuse because they are more likely to have conditions that require pain relief. The OIG intends to look at the issue from both the beneficiary side and the prescriber side. The overall goal of the study is to generate “baseline data about beneficiaries receiving extreme amounts of opioids and prescribers with questionable patterns for opioids in Medicaid.”
Authored by: Michaela D. Poizner,
Advisory Opinion 17-06 joins a long list of opinions approving arrangements between a Medicare Supplemental Health Insurance (Medigap) insurer and a preferred hospital organization (PHO). While this advisory opinion does not offer new insights with respect to Medigap/PHO arrangements, the OIG has remained consistent in its approach to them.
As with prior similar requests, the Medigap insurer here sought approval of an agreement in which it would contract with a PHO, and the hospitals within the PHO’s network would provide discounts of up to 100 percent on the Medicare Part A inpatient hospital deductibles covered by the insurer. The hospitals would not provide any additional benefits to the Medigap insurer or its policyholders, and the insurer would pay a fee to the PHO for administrative services each time it received a discount. The Medigap insurer would also return a portion of the savings to those policyholders who had an inpatient stay at a network hospital via a $100 credit toward their next renewal premium. The use of non-network hospitals would not subject policyholders to penalties or otherwise affect liability for costs covered by the Medigap plans.
Authored by: Andrew J. Droke,
In response to President Trump’s declaration of the opioid crisis as a public health emergency, the Office for Civil Rights (OCR) released guidance intended to educate health care providers on how they can respond to requests for protected health information (PHI) during an opioid crisis. OCR’s guidance does not reveal any new or revised standards for disclosure of PHI, but rather it instructs health care providers on how existing HIPAA rules apply to sharing PHI with a patient’s family members, close friends or legal representative during a crisis situation, such as an opioid overdose.
The guidance illustrates how PHI may be shared without the patient’s consent in an opioid crisis, but the prevailing HIPAA rules permit disclosure of PHI any time the criteria noted below are satisfied. Specifically, providers may share PHI:
- with a patient’s family, and close friends when doing so is in the best interests of an incapacitated or unconscious patient; and
- when doing so would prevent or diminish a serious and imminent threat to the patient’s health and safety.
The Department of Justice (DOJ) imposed False Claims Act penalties against First Coast Cardiovascular Institute (FCCI) for failing to work credit balances and repay overpayments to federal health care programs. On October 13, 2017, DOJ announced that FCCI agreed to pay $448,821 to resolve False Claims Act allegations brought by a former employee of FCCI. The qui tam lawsuit alleged that FCCI wrongfully delayed repayment of approximately $175,000 in potential overpayments to federal health care programs beyond 60 days. This settlement represents a warning to providers who intentionally drag their feet in the face of a potential overpayment, and fail to diligently investigate and repay monies owed to federal health care programs. Authored by: Stewart W. Kameen,
Reviewed by: William T. Mathias, 410.862.1067, firstname.lastname@example.org
As recovery efforts take center stage in areas affected by natural disasters that have recently impacted our nation, it is critical that the long term care industry is aware of the unique issues presented by these events.
This webinar covers the regulatory framework relevant to this industry, including new requirements that went into effect on November 15, 2017, as well as additional changes sometimes implemented post-event, and the rules and requirements specifically applicable to entities who may be eligible for aid through federally funded relief programs, including those administered through the Federal Emergency Management Agency. The session concludes with recommendations for disaster response and preparedness, including a summary of common issues and best practices to minimize risks. Presented by Baker Donelson attorneys Ernest B. Abbott, Wendy Huff Ellard, Meredith N. Larson, and Danielle Trostorff.
Co-Chairs, Health Care Regulatory Group