Texas Torches Telemedicine? Board Issues Emergency Rule

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Update: Teladoc has filed for and obtained a temporary restraining order enjoining the Board’s proposed Emergency Rule.

The Texas Medical Board issued an Emergency Rule with proposed changes to the practice standards and disciplinary guidelines for remote prescribing via telemedicine consults. The Emergency Rule states that the use of online questionnaires, or questions and answers exchanged through email, electronic text or chat, or telephone evaluation of a patient are not adequate to establish a valid physician-patient relationship under the Texas regulations. The Emergency Rule states that the physician must perform a physical examination via a face-to-face visit or in-person evaluation. The Emergency Rule carves out mental health services from this in-person evaluation requirement. The changes in the Emergency Rule affect Texas Administrative Code, Title 22, Part 9, Section 190.8(1)(L). Continue reading this entry

Look at What New York Did With Telemedicine to Bring in the New Year

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It’s party time in the Big Apple as New York becomes the 22nd state to enact a telemedicine commercial reimbursement statute. The legislation was sponsored by Senator Catharine Young (R) and signed into law by New York Governor Andrew Cuomo (D), representing bi-partisan support to facilitate patient access to telemedicine services through private sector growth and development. The law requires commercial insurers to cover services provided via telemedicine and telehealth. The law also contains protections for patients by not allowing deductibles, co-insurance or other conditions for coverage of telemedicine that differ from those conditions applicable to in-person services. On its face, the law takes effect January 1, 2015 and applies to all policies and contracts issues, renewed, modified, altered or amended after that date. However, as a practical matter, it is expected that insurance policies will not likely be updated until later in the year in order to allow time to facilitate implementation of the new requirements. Continue reading this entry

Affordable Care Act Co-Op Health Insurer Placed Into Rehabilitation by Iowa Insurance Commissioner

Regulatory-Developments

The Iowa Insurance Commissioner obtained an Order for Rehabilitation with respect to CoOportunity Health, Inc. (“CoOportunity”) on December 24, 2014. With the Rehabilitation Order, the Iowa Insurance Commission took possession of CoOportunity’s assets and will administer CoOportunity under the general supervision of the Iowa District Court.

The Iowa Insurance Commissioner has indicated that it is currently evaluating the totality of CoOportunity’s situation and the full impact of the rehabilitation. It has issued initial guidance to CoOportunity’s reported approximately 96,000 insureds, as well as its providers and producers. Insureds may continue insurance with CoOportunity while it is in rehabilitation, so long as they pay the required premium payment, but individuals also may enroll in other plans beginning February 1, 2015. One effect on customers who may select new coverage on February 1 is that any deductible payments made in January will not count for the new plan. If an acceptable rehabilitation plan for CoOportunity to remain viable is not developed, the Rehabilitator will seek liquidation. While CoOportunity may remain a Qualified Health Plan under the Affordable Care Act, that could be affected by a liquidation and the resulting guaranty fund’s limits that would limit coverage to $500,000 per individual. The guideline indicates that if CoOportunity fails to be a Qualified Health Plan, its enrollees would not be eligible for tax credit subsidies available under the Affordable Care Act. Continue reading this entry

Government's Health Care Fraud "Cash Cow" Keeps Mooing

Recent Decision Underscores Need for Involvement of Counsel in Internal Investigations

In a conversation with Lee Pacchia from Mimesis Law, Foley & Lardner Partner, Lisa Noller, discusses the Government’s approach to health care fraud prosecutions and what companies can expect in 2015.

Since 2007, the Department of Justice (DOJ) has increased its affirmative civil and criminal enforcement priorities. Rather than relying on whistleblowers to come forward and make a complaint, the DOJ now actively reviews its claims and other statistical data, using fiscal intermediaries to analyze denials of claims, sending third party contractors to conduct on-site surveys and increasing the use of wiretaps. These tools are in addition to reviewing all whistleblower complaints for potential criminal cases, and more traditional methods of law enforcement such as wire taps and patient interviews. Congress also has significantly increased funding to combat fraud and abuse.

With more coordination among administrative, civil and criminal agencies, the DOJ’s health care fraud prosecutions are up 75% since 2007, and in 2014 alone, netted the Government more than $2.3 billion.

In 2015, regulatory changes and developments likely will revolve around continued ACA implementation, the Sunshine Act and the 60-Day Refund Rule. And of course, traditional methods of criminal enforcement will continue.