"Nationwide Healthcare Lawyers"
(August 29, 2014) The American Cancer Society has estimated that 43.92% of all males and 38.00% of all females in the United States will develop cancer at some point during their lifetime. While a number of clinical advances have been made over the last 25 years, chemotherapy remains one of the predominant tools used to […]
Oncology Fraud: Michigan Oncologist Indicted Read More »
(August 31, 2014): The Healthcare Quality Improvement Act of 1986[1] (“HCQIA”, generally pronounced “Hick Kwah”), affords peer-reviewing bodies and their members legal immunity from liability from suits by the physicians they discipline, so long as their peer-review processes include certain due process rights for the accused physician. Unfortunately, the provider peer review process is irrevocably
Peer Review: How HCQIA Due Process is a Fiction Read More »
(August 23, 2014): Almost all health care providers and suppliers qualify as a “covered entity” under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Together with the “business associates” with whom they work, these entities are responsible for ensuring that any protected health information (PHI) under their control has been properly secured and
A HIPAA Risk Assessment is Essential to Avoid Liability Read More »
(August 21, 2014): Nursing facilities are required and expected to report any and all allegations of patient abuse or neglect to ensure patient safety. A recent study of their records by the Department of Health and Human Services’ Office of Inspector General (OIG) has found that a number of these facilities have not been fully
OIG Finds Nursing Homes Not Reporting Patient Abuse and Neglect Read More »
(August 6, 2014): The Centers for Medicare & Medicaid Services (CMS) has extended its year-long HHA enrollment moratoria on the enrollment of new home health agencies and ground ambulance suppliers in several major metropolitan areas. Furthermore, CMS has broadened its temporary enrollment moratoria so that it applies not only to Medicare, but also to enrollment
CMS Extends HHA Enrollment Moratoria Read More »
(July 30, 2014): In recent years, both the type and the frequency of Medicare and Medicaid audits of health provider and supplier claims have greatly increased. Not surprisingly, these administrative enforcement actions have led to a wide variety of adverse collateral effects, ranging from Medical Board investigations to the initiation of private payor audits. Notably,
Mandatory Compliance Programs for Medicaid & Medicaid Providers? Read More »
(July 23, 2014): Rightly or wrongly, critics of our nation’s long-term care system have long cited incidents of patient abuse, neglect, and the alleged misappropriation of funds among the identified widespread problems many seniors face when receiving long-term care and treatment services. In an effort to address these problems, legislators were sure to include provisions
OIG Report on the Nationwide Background Check Program Read More »
(July 16, 2014): In 2005, the Centers for Medicare and Medicaid Services (CMS) revised and implemented surveyor guidance pertaining to the role of medical directors in long-term facilities. This guidance gives surveyors and providers more information about the role of a medical director, which is outlined in regulation 42 C.F.R. §483.75 (i). It also helps
CMS Guidance on the Role of a Medical Director Read More »
(July 16, 2014):The term “medical necessity” has varying definitions depending on who is using it. Providers, physicians, courts, private insurers, state governments, and the federal government all have their own interpretation of what constitutes medical necessity. This changing definition of medical necessity can be problematic when a provider’s claims are audited by a Zone Program
The Changing Definition of Medical Necessity Read More »
(July 7, 2014): As of July 1, 2014, Medicare-certified hospices must directly submit a Hospice Item Set (HIS) (for Admission and Discharge) records for each patient admission that occurs on or after July 1. These HIS records must be completed on an ongoing basis and submitted electronically the Centers for Medicare & Medicaid Services. Any
Hospice Providers – New HIS Record Requirements! Read More »