In April 2019, the United States Department of Justice (“DOJ”), Criminal Division, issued a guidance document entitled “Evaluation of Corporate Compliance Programs.”[1] This guidance updates standards the DOJ utilizes to investigate, charge, and negotiate criminal charges related to corporate crimes.[2] Although the DOJ recognizes that each company has its own set of unique risks, its investigations often include three common questions in assessing the effectiveness of a company’s corporate compliance program.

In mid-February 2019, the Centers for Medicare and Medicaid Services (“CMS”), Innovation Center and the Department for Health and Human Services (“HHS”) announced a ground-breaking payment and medical services initiative for ambulance providers called “Emergency Triage, Treat and Transport” (the “ET3”). This new model is the first step in allowing providers of Emergency Medical Services to finally “take off the gloves” to fully utilize both their medical skills and unique patient knowledge to implement a more efficient and effective care model.

This article appeared in the December edition of MD-UPDATE, available at  http://www.md-update.com/wp-content/uploads/2018/12/MD-Update-Issue-118/#?page=8

Prevention and compliance best practices for healthcare providers are a hot topic, and this isn’t likely to change, maybe ever. As the opioid crisis continues to grow and healthcare providers come under increasing scrutiny, one tool is emerging as a resource for prescribing providers, and it’s probably not what you would expect: KASPER, Kentucky’s prescription reporting database. Below are three ways to get the most out of KASPER to keep your practice in compliance.

As medical advancements and patients in need of medical care continue to increase, the role of mid-level practitioners becomes even more crucial.  While there have been many turns of phrase for these medical professionals, the term “mid-level practitioner” is meant to encompass those non-physician providers, which include advanced practice nurses and physician assistants, among others. In Kentucky, there has been a shortage of primary care providers, which is particularly problematic in the state’s many rural areas.  This in turn has led to the push for more autonomy to these integral medical providers. While there are many reasons why this development is an improvement for patients and providers alike, this also leads to more liability exposure. 

In an evolving world of cyber terrorism where individuals such as Edward Snowden grab headlines by stealing national secrets, it should come as no surprise that protected healthcare information (“PHI”) kept by providers has become a “target rich environment” for foreign governments and individual hackers alike. In addition to threats from outside entities, healthcare providers must also realize and appreciate that state and federal regulatory and statutory requirements govern the creation, maintenance and protection of PHI, including through but not limited to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Health Information Technology for Economic and Clinical Health (“HITECH”) Act.  Failure to abide by these complex and stringent rules can lead to significant penalties. 

In July of 2014, Kentucky Medicaid established an Alternate Payment Methodology (“APM”) for all Federally-Qualified Health Centers (“FQHCs”) and Rural Health Clinics (“RHCs”) as an alternative to the all-inclusive encounter rate per patient under the standard prospective payment system (“PPS”) of 42 U.S.C. 1369a(aa). The APM allows for qualified centers to be reimbursed at a rate of 125% of the 2014 Medicare Upper Payment Limit for RHCs in place of the PPS system ($99.75 per covered visit). There are more advantages to APM than meet the eye, however, and qualified centers currently using PPS method should at the very least reevaluate APM, as proposed changes will make APM even more attractive and potentially risk-free.

Urine toxicology, also referred to as urine drug screening, is an important procedure that health providers use for several reasons: to monitor patients’ medication compliance, detect drug abuse, or identify the presence of disease. There are numerous implications that accompany a urine toxicology examination though, and health providers are sometimes left wondering if they should hand over the cup to patients.

“The single biggest and most common compliance weakness is the lack of a timely and thorough risk analysis.”

On June 23^rd, the Healthcare Law Blog discussed the Fraud Alert recently issued by the Office of Inspector General of the United States Department of Health and Human Services regarding physician compensation arrangements which telegraphed the Office of Inspector General’s intention to increase scrutiny of financial arrangements between physicians and providers to whom physicians make referrals. In today’s post, we examine the steps physicians and other healthcare providers should take to ensure that any financial relationships are in compliance with federal statutes and regulations.