The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2013 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCU) (OEI-06-13-00340, March 2014). As part of their state Medicaid plans, all states must operate a MFCU or convince HHS that it is not cost-effective to do so and that other fraud protections are in place. In FY 2013, 49 states and the District of Columbia had MFCUs. The MFCUs investigate allegations of fraud as well as allegations of patient abuse and neglect. HHS-OIG oversees the MFCUs and administers grants that provide federal funding for MFCU operations. Federal funding reimburses 75% of operating costs, while the remainder is contributed by the states.
In June 2013, Florida’s legislature significantly amended Florida’s False Claims Act, Fla. Stat. §§ 68.081-68.092 (“FFCA”), effective July 1, 2013. Although these amendments have not received much publicity or commentary, they considerably expanded the FFCA’s scope, among other important changes. Persons potentially subject to the FFCA, including those who seek and receive payments from the state, should carefully review and consider these amendments, and also consider revising their compliance policies accordingly. Continue reading this entry
The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services’ Office of Inspector General (OIG) finalized amendments to the Physician Self-Referral Law (Stark) and Anti-Kickback Statute regulations (the Regulations) on December 27, 2013, regarding the donation of electronic health records (EHR) systems. Among other important changes, CMS and the OIG extended the Regulations, which were originally scheduled to “sunset” on December 31, 2013, to December 31, 2021.
The extension of the sunset period became effective December 31, 2013; all other changes to the Regulations will be effective on March 27, 2014.
Since their adoption in 2006, the Regulations have enabled hospitals and other providers and suppliers to subsidize up to 85 percent of the costs of EHR software and/or information technology and training services that are necessary and used “predominately” to create, maintain, transmit or receive electronic health records. Continue reading this entry
The U.S. Department of Health and Human Services (HHS) recently issued guidance on when it may be permissible under the Health Insurance Portability and Accountability Act (HIPAA) for health care providers to share information related to a patient’s mental health, HIPAA Privacy Rule and Sharing Information Related to Mental Health. Of note, the new guidance clarified instances where a health care provider may communicate with a patient’s family members or friends regarding a patient’s mental health, including the sharing of a minor’s mental health information with the minor’s parents.
In the new guidance, HHS clarified that when the patient is present and has the capacity to make health care decisions, health care providers may communicate with a patient’s family members, friends, or other persons that the patient has involved in his or her health care or payment for care, so long as the patient does not object.
Such a communication may occur, for instance, when a patient invites his or her family member to the patient’s treatment session, and the family member is present in the treatment room with the patient. However, the health care provider may share or discuss only the information that the person involved needs to know about the patient’s care or payment for care. Otherwise, if the patient has capacity and objects to the provider sharing information, the provider may share the information only if doing so is consistent with applicable law and standards of ethical conduct, and the provider has a good faith belief that the patient poses a threat to the health or safety of others, and the person to whom information is disclosed is reasonably able to prevent or lessen the threat. Continue reading this entry
February is the last date Recovery Audit Contractors (RACs) and Medicare Administrative Contractors (MACs) can issue additional documentation requests (ADRs) as the current Recovery Audit Program contracts are coming to a close. This will give providers a much-needed “intermission” in recovery audits until the Centers for Medicare and Medicaid Services (CMS) finalize and select winning bidders for the next round of contracts. The new RAC and MAC contracts will introduce some much-desired changes to the Recovery Audit Program. Continue reading this entry