Bill Extending Funding For Certain Veteran Medical and Other Projects Heads To President

September 25, 2011

H.R.2646

Extended funding for various veterans health facilities and programs and audits of private payers providing certain services to veterans provided for under the Veterans Health Care Facilities Capital Improvement Act of 2011, H.R. 2646 are about to become law.  Congress has passed and sent H.R. 2646 to President Obama for signature.

Among other things, H.R. 2646:

  • Designates the VA telehealth clinic in Craig, Colorado, as the “Major William Edward Adams Department of Veterans Affairs Clinic.”
  • Extends to December 31, 2018, specified authority for: (1) treatment, rehabilitation, and added services for seriously mentally ill and homeless veterans; (2) housing assistance for homeless veterans; and (3) the Advisory Committee on Homeless Veterans and (4) transfers of real property under the Secretary’s jurisdiction or control.
  • Extends to September 30, 2020, the recovery audit program for certain fee basis and other medical services contracts concerning non-VA care and services for veterans and beneficiaries
  • Eextends funding for construction at Department of Veterans Affairs (VA) medical centers in Seattle, Washington and West Lost Angeles, California; and leases at various outpatient and community-based outpatient clinics.  
  • Changes authorizations for certain previously authorized construction projects in Fayetteville, Arkansas, the Orlando, Florida area, Palo Alto, California, San Juan, Puerto Rico, and St. Louis, Missouri.
  • Along with these funding extensions, H.R. 2646 also requires that requests for funding of  veteran medical facilities projects and leases sent to Congress include: (1) a detailed estimate of the total costs of the medical facility including the number of personnel and itemized costs for construction, activation, special purpose alteration, ancillary services, and equipment; and (2) data concerning demographics, workload, utilization, and operating costs over a 5-, 10-, and 20-year period.  For  a proposed new or replacement facility, funding requests also must include a detailed: (1) report of the consideration given to acquiring an existing facility by lease or purchase and to the sharing of health-care resources with the Department of Defense (DOD); and (2) total cost estimate and a cost-benefit comparison for each considered alternative to construction of the facility and an explanation of why the preferred alternative is the most effective means to achieve the stated project goals.

For Assistance or Additional Information

Nationally and internationally known for her knowledge and work on health and other employee benefit matters and engaging and informative presentations, attorney, author and policy advocate Cynthia Marcotte Stamer will help you prepare your plan and organization to cope with these and other challenges of understanding and coping with health care reform. 

Chair of the American Bar Association (ABA) RPPT Employee Benefits & Other Compensation Arrangements, an ABA Joint Committee on Employee Benefits Council Representative, incoming ABA TIPS Employee Benefit Plan Committee Vice Chair, former ABA Health Law Section Managed Care & Insurance Interest Group Chair, past Southwest Benefits Association Board Member, Employee Benefit News Editorial Advisory Board Member, Board Certified in Labor and Employment Law and a widely published speaker and author,  Ms. Stamer has more than 24 years experience advising businesses, plans, fiduciaries, insurers and governments on health care, retirement, employment, insurance, :and tax program design, administration, defense and policy and related employment, insurance and health care matters.    Her experience includes extensive experience  advising insured and self-insured ERISA group medical and other plans,  Medicare and Medicaid Advantage plans, mini-med, high-deductible and other consumer driven medical, long-term care, occupational injury, ex-pat, association, fraternal benefit and other managed care and medical benefit plans and insurers, their service providers,  insurers,  sponsors, fiduciaries, technology providers and others.   A primary drafter of the Bolivian pension law, Ms. Stamer also has more than 30 years experience working on legislative and regulatory health care, pension, workforce, education and immigration reform matters including extensive work on the Pension Protection & Affordable Care Act, HIPAA, COBRA, state managed care and other  insurance and other laws.  In addition to her experience advising governments and others internationally about these matters, she  regularly advises and represents employers, employee benefit plans, insurers, health care and managed care providers and others about evolving laws and regulations and assists them in dealing with Congress, the Internal Revenue Service, the Department of Labor, Immigration and Customs, OCR, OIG, CMS and other HHS agenices, the FTC, the Justice  Department, state insruance and health departments, and others.

 A widely published author and popular speaker, Ms. also regularly publishes and speaks for a broad range of organizations  including American Bar Association, Aspen Publishers, World At Work, Benefits Magazine, Employee Benefit News, Spencer Publications, SHRM, the International Foundation, Solutions Law Press and many others.  She  currently or previously has served on the editorial advisory board of Employee Benefits News,  BNA Employee Benefits CDRolm and a wide range of other highly regarded publications.  Her insights on these and other matters have appeared in Managed Care Executive, Health Leaders, Private Payers News, the Wall Street Journal, various publications of  the Bureau of National Affairs, Aspen, Atlantic Information Serices, the Wall Street Journal, and many other industry and news publications.   In recognition of this extensive record of employee benefit experience and involvement, Ms. Stamer recently was selected to be inducted as a Fellow in the American  College of Employee Benefits Counsel.

You can learn more about Ms. Stamer and her experience, review some of her other training, speaking, publications and other resources, and register to receive future updates about developments on these and other concerns from Ms. Stamer here. For important information concerning this communication click here.

About Solutions Law Press

Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources available at www.solutionslawpress.com

THE FOLLOWING DISCLAIMER IS INCLUDED TO COMPLY WITH AND IN RESPONSE TO U.S. TREASURY DEPARTMENT CIRCULAR 230 REGULATIONS.  ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, OR (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.

©2011 Cynthia Marcotte Stamer, P.C.  Non-exclusive license to republish granted to Solutions Law Press.  All other rights reserved.


9/21 NTHCPA Meeting To Focus On Quality Measures & Reimbursement

September 16, 2011

NORTH TEXAS HEALTHCARE COMPLIANCE PROFESSIONAL ASSOCIATION

Invites Members and Guests to Our Next Study Group & Brown Bag Luncheon

“Quality Measures and Reimbursement: New Programs, New Compliance Challenges”

Featuring

Timothy D. Martin, J.D., LL.M, CCP, MCP

Wednesday, September 21, 2011
Noon-2:00 p.m.
Dallas Ft Worth Hospital Council

250 Decker Drive, Irving, TX 75062-2706 

North Texas Healthcare Compliance Professional Association (NTHCPA) invites members and other interested health care compliance professionals to join other NTHCPA members and guests on Wednesday, September 21, 2011 from Noon to 2:00 p.m. as Timothy D. Martin, J.D., LL.M, CCP, MCP, leads a program on “Quality Measures and Reimbursement: New Programs, New Compliance Challenges.”  

The expanding use of payment incentives for meeting quality benchmarks by private and public payers create new opportunities and new compliance challenges.  The Affordable Care Act created a number of new quality incentive programs that build on earlier ones. Texas has also created new quality incentive programs with the passage of its healthcare collaborative initiative. While most health quality incentives continue to rely on structure, process, and outcome measures that the healthcare industry has experimented with for many years, new compliance requirements require providers to change their data-gathering and data-communication procedures. Further, these programs may force providers to deal with clinical guidelines that lag behind the standard of care and data-transmission protocols that lag behind reporting requirements. Newer bundled-payment methodologies may require healthcare organizations to create a complex contractual web to allocate a single payment among multiple providers. This discussion will focus on these issues and their possible solutions.

The meeting will be held at the offices of the Dallas Ft Worth Hospital Council, 250 Decker Drive, Irving, TX 75062-2706.  Under the new brown bag luncheon format, members and guests are encouraged to bring along a lunch of their choosing and participate in this compliance knowledge and skill-building and networking event.

Timothy D. Martin, J.D., LL.M, CCP, MCP was a founder and Chief System Architect for Innovative Managed Care Systems, LLC (now MedAssets, Inc.). He has more than 30 years’ experience in information technology—the last 20 years in healthcare information technology. He holds a degree in Mathematics and Computer Information Systems from West Texas State University and two law degrees from Southern Methodist University Dedman School of Law.

NTHCPA meetings are open to all NTHCPA members and other interested health care compliance professionals. Participation in the meeting is complimentary. Participants are responsible for any parking charges incurred. 

RSVP & Register For Invites & Updates

To help us to notify you about upcoming meetings and to arrange for adequate space for this and other meetings, interested persons are encouraged to forward their current contact information including e-mail to Vice-President Cynthia Marcotte Stamer at (469) 767-8872 or by e-mail here.  Stay on top of information about upcoming meetings and share and dialogue with other NTHCPA members about health care compliance challenges and developments by joining our Linked In Group here.  Please feel free to share this invitation with others who may be interested. 

About the NTHCPA & Involvement

NTHCPA exists to champion ethical practice and compliance standards and to provide the necessary resources for ethics and compliance Professionals and others in North Texas who share these principles.  The vision of NTHCPA is to be a pre-eminent compliance and ethics group promoting lasting success and integrity of organizations within North Texas.  To register or update your registration or to receive notice of future meetings, e-mail here.

Would you like to get more involved?  We encourage persons interested in serving on the steering committee, sponsoring refreshments for an upcoming meeting, wish to suggesting topics or speakers, or seeking more information about membership or involvement with the NTHCPA to contact:

NTHCPA President Erma Lee at (817) 927-1232 or by e-mail here or

Vice-President Cynthia Marcotte Stamer at (469) 767-8872 or by e-mail here

This communication may be considered a marketing communication for certain purposes.  If you wish to update your e-mail for purposes of receiving future e-mail concerning meetings or other activities of the North Texas Healthcare Compliance Professionals Association , please send an email here.

Please share this invitation with others who might be interested in this topic or other NTHCPA events!


UCLA Health Systems Payment of $865,500 To Settle HIPAA Charges Shows Rising HIPAA Risk

September 15, 2011

Health care providers, health plans, health care clearinghouses and their business associates got another wake up call about the growing importance of strengthening their policies, practices and safeguards of medical information and records that are “protected health information” under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules with the announcement on July 7 that the University of California at Los Angeles Health System (UCLAHS) has reached an agreement with the U.S. Department of Health & Human Services Office of Civil Rights (OCR) to pay $865,500 and act to strengthen its health information privacy and security practices to settle charges of HIPAA violations.

The latest in a series of recently announced high-dollar Resolution Agreements, the UCLAHS Resolution Agreement highlights the growing risks that covered entities and their business associates run by failing to adequately adopt and administer the policies, systems and other management controls and training necessary to ensure that their organizations and their employees and other members of their workforce actually operationally comply with HIPAA.

Increased penalties, tighter rules and recent enforcement actions by OCR make it more important than ever that covered entities tighten their compliance and risk management policies and procedures.

As a result of amendments enacted as part of the HITECH Act, Congress modified and expanded the HIPAA audit and enforcement obligations of OCR, amended and expanded the potential penalties, made business associates liable for violation of the privacy rules like covered entities, added an obligation for covered entities and business associates to provide notification of breaches of unsecured PHI and tightened other HIPAA obligations. The HITECH Act also gave state attorneys general to bring civil lawsuits against covered entities and business associates that commit HIPAA violations that injure citizens in their state under certain circumstances. Eventually, individuals injured by HIPAA violations will get the right to share in a portion of certain HIPAA recoveries. See HIPAA Heats Up: HITECH Act Changes Take Effect & OCR Begins Posting Names, Other Details Of Unsecured PHI Breach Reports On Website.

OCR enforcement actions and statistics make clear that OCR is serious about investigation and enforcement of HIPAA violations. This Spring, OCR assessed its first civil monetary penalty (CMP) under HIPAA – a $4.3 million against Cignet Health of Prince George’s County, Md. (Cignet) and entered into a series of Resolution Agreements under which CVS Pharmacy, Inc., General Hospital Corporation and Massachusetts General Physicians Organization Inc., Rite Aid and others paid a million or more dollars as part of the required terms of settlement. See e.g., Rite Aid Pays $1 Million HIPAA Privacy Settlement As OCR Tightens HIPAA Regulations; HIPAA Risks Soar As CVS Agrees To Pay $2.25 Million To Resolve HIPAA Charges & Stimulus Bill Amends HIPAA; Providence To Pay $100,000 & Implement Other Safeguards To Settle HIPAA Penalty Exposures Under HIPAA. Meanwhile, as of January 1, 2011, OCR reported that it had referred more than 484 Privacy Rule breach investigations to the Department of Justice for consideration for potential criminal prosecution and required changes in privacy practices and other corrective actions as part of the requirements for resolution of an additional 12,781 of cases investigated. In addition to these civil enforcement actions by OCR, the Department of Justice has secured several criminal convictions or pleas under HIPAA’s criminal provisions. OCR data confirms that the covered entities involved in these actions included health care providers, health plans, and others. See, e.g., 2 New HIPAA Criminal Actions Highlight Risks From Wrongful Use/Access of Health Information

Lax HIPAA and other practices for protection of medical and other confidential personal information also increasingly exposes covered entities and other organizations to liability under state laws. State courts allow individual plaintiffs to rely on violations of HIPAA as the basis for bringing state privacy, retaliation or other actions. See, e.g. Sorensen v. Barbuto, 143 P.3d 295 (Utah Ct. App. 2006), Acosta v. Byrum, 638 S.E. 2d 246 (N.C. Ct. App. 2006). Private plaintiffs employed by covered entities also claim HIPAA related misconduct as the basis for their retaliation claims. See, e.g.,  Retaliation For Filing HIPAA Complaint Recognized As Basis For State Retaliatory Discharge Claim.

HIPAA-specific exposures, wrongful use, access or disclosure of medical information also can expose covered entities, members of their workforce and others improperly using, accessing or disclosing protected health information to liability under other federal or state laws. See, Cybercrime & Identity Theft: Health Information Security Beyond HIPAA; NY AG Cuomo Announcement of 1st Settlement For Violation of NY Security Breach Notification Law; Woman Who Revealed AIDs Info Gets A Year.

These and other developments make clear that covered entities and their business associates must get serious about HIPAA compliance and risk management. These organizations should review and tighten privacy policies, breach and other monitoring, training and other practices to mitigate against exposures in light of recently tightened requirements and new enforcement risks.

For More Details Or Help With HIPAA & Other Risk Management & Compliance Needs

To learn more about the UCLAHS Resolution Agreement and other risk management tips, see UCLA Health Systems Payment of $865,000 To Settle HIPAA Charges Shows Rising HIPAA Risk.

If you need assistance monitoring federal health reform, policy or enforcement developments, or to review or respond to these or other health care or health IT related risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer, can help.  Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 23 years experience advising health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health care providers, health plans, their business associates and other health industry clients to establish and administer medical privacy and other compliance and risk management policies, to health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. She regularly designs and presents HIPAA and other risk management, compliance and other training for health plans, employers, health care providers, professional associations and others.   

Ms. Stamer also regularly works with OCR and other agencies, publishes and speaks extensively on medical and other privacy and data security, health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  For instance, On May 3, 2011, Ms. Stamer served as the appointed scribe for the ABA Joint Committee on Employee Benefits Agency meeting with OCR and will moderate a teleconference featuring comments by OCR’s Susan McAndrew for the Joint Committee on Employee Benefits scheduled for May 16. Her insights on the required “culture of compliance” with HIPAA also recently were quoted in medical privacy related publications of the Atlantic Information Service. Among others, she has conducted privacy training for the Association of State & Territorial Health Plans (ASTHO), the Los Angeles Health Department, the American Bar Association, the Health Care Compliance Association, a multitude of health industry, health plan, employee benefit and other clients, trade and professional associations and others. You can get more information about her HIPAA and other experience here. To ask for legal help with these or other compliance concerns, inquire about arranging for compliance audit or training, or matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here. You can review other publications and resources and additional information about the employment, employee benefits and other experience of Ms. Stamer here and register to receive future updates about developments on these and other concerns from Ms. Stamer here. For important information concerning this communication click here.Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources available at www.solutionslawpress.com.

THE FOLLOWING DISCLAIMER IS INCLUDED TO COMPLY WITH AND IN RESPONSE TO U.S. TREASURY DEPARTMENT CIRCULAR 230 REGULATIONS. ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, OR (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.

 

©2011 Cynthia Marcotte Stamer, P.C. Non-exclusive license to republish granted to Solutions Law Press. All other rights reserved.


Indictment of 91 Shows Growing Health Care Fraud Enforcement Risk

September 8, 2011

A nationwide takedown by Medicare Fraud Strike Force operations in eight cities resulted in the Department of Justice filing criminal charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing, Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius jointly announced the charges on September 7, 2011.

The charges are provide yet another powerful reminder to health care providers, leaders and organizations of the advisability of tightening compliance practices and taking other steps to guard against ever expanding health care fraud exposures.  Already a lead federal enforcement priority for more than a decade, HHS recently established the Center for Program Integrity within the Centers for Medicare & Medicaid Services (CMS) to focus on identifying and stopping fraud and acting swiftly to protect beneficiaries.

Charges Announced September 7 Show Strike Force Targeting Fraud Industry Wide

In announcing the most sweeping joint action to date, HHS and Justice Department officials warned that the latest charges demonstrate the willingness and commitment of federal officials to find and prosecute health care fraud throughout the health care industry.  The actions are the latest in a series of strong reminders to providers, leaders and others in the health care industry of the need to tighten compliance and risk management to minimize the risk of getting caught up in the Federal government’s ever-tightening health care fraud investigation and enforcement net.

The charges made against the 91 defendants in the indictments announced cover nearly the entire spectrum of healthcare providers for a variety alleged fraudulent schemes. The defendants charged are accused of various health care fraud-related crimes, including conspiracy to defraud the Medicare program, health care fraud, violations of the anti-kickback statutes and money laundering.  The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, physical and occupational therapy, mental health services, psychotherapy and durable medical equipment (DME).   HHS and Justice Department Officials warned these latest sweeping charges clearly signal the resolve of the federal government to find and prosecute health care fraud throughout the industry.  Learn more details about September here.

According to the Justice Department and HHS, 70 individuals were charged by Strike Force prosecutors in indictments unsealed on September 6 and September 7, 2011 in six cities.  The indictments allege a variety of Medicare fraud schemes involving approximately $263.6 million in false billings.  As part of takedown operations last week, 18 additional defendants were charged in Detroit and one defendant was charged in Miami in cases unsealed on September 1, 2011, for their alleged roles in Medicare fraud schemes involving approximately $29.4 million in fraudulent claims.  Additionally, two individuals are scheduled to appear in court on September 7, 2011 on charges filed on August. 24, 2011, for their roles in a separate $2 million health care fraud scheme.  According to the September 7 announcement, this coordinated takedown involved the highest amount of false Medicare billings in a single takedown in Strike Force history.

According to court documents, the defendants located in Miami, Houston, Baton Rouge, Los Angeles and Detroit allegedly participated in a diverse array of schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided.  In many cases, indictments and complaints allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. Collectively, the doctors, nurses, medical professionals, health care company owners and others charged in the indictments and complaints are accused of conspiring to submit a total of approximately $295 million in fraudulent billing.  If convicted, the defendants face a broad range of criminal, civil and administrative sanctions including imprisonment, criminal penalties, civil sanctions, federal program disqualification, state licensing board disciplinary action and other consequences.

Charges Part of Ongoing National Anti-Health Care Fraud Campaign

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  The joint Department of Justice-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.  Since its announcement, the Strike Force has used the combined resources of agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies to investigate and prosecute a rising number of organizations and individuals throughout the industry for alleged violations of Federal health care fraud prohibitions.  In their September 7, 2011 announcement, HHS and DOJ credited Strike Force Operations in nine locations with resulting in charges against more than 1,140 defendants who the government charged collectively falsely billed the Medicare program for more than $2.9 billion.

In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are using a wide range of new and old tools in their campaign against what they perceive as fraudulent providers and to deter other perceived aggressiveness by health care providers and organizations.  See e.g., U.S. to use software to crack down on Medicare, Medicaid, CHIP fraud;   Health Care Fraud Enforcement Packs New Heat; OIG Shares Key Insights On When Owners, Officers & Managers Face OIG Program Exclusion Based On Health Care Entity Misconduct; OIG Launch of Health Care Fraud “Most Wanted” List Sign of Enforcement Risks; CMS Delegated Lead Responsibility For Development of New Affordable Care Act-Required Medicare Self-Referral Disclosure Protocol; HHS announces Rules Implementing Tools Added By Affordable Care Act to Prevent Federal Health Program Fraud.

The effectiveness of these Federal efforts to deter, find and prosecute false claims and other perceived abuses of Federal health care law has been significantly strengthened since Congress passed the Patient Protection & Affordable Care Act (Affordable Care Act).  Among other things, ACA empowered HHS to:

  • Suspend payments to providers and suppliers based on credible allegations of fraud in Medicare and Medicaid;
  • Impose a temporary moratorium on Medicare, Medicaid, and CHIP enrollment on providers and suppliers when necessary to help prevent or fight fraud, waste, and abuse without impeding beneficiaries’ access to care.
  • Strengthen and build on current provider enrollment and screening procedures to more accurately assure that fraudulent providers are not gaming the system and that only qualified  health care providers and suppliers are allowed to enroll in and bill Medicare, Medicaid and CHIP;
  • Terminate providers from Medicaid and CHIP when they have been terminated by Medicare or by another state Medicaid program or CHIP;
  • Require provider compliance programs, now required under the Affordable Care Act, that will ensure providers are aware of and comply with CMS program requirements.

Act To Manage Risks

In response to the growing emphasis and effectiveness of Federal officials in investigating and taking action against health care providers and organizations, health care providers covered by federal false claims, referral, kickback and other health care fraud laws should consider auditing the adequacy of existing practices, tightening training, oversight and controls on billing and other regulated conduct, reaffirming their commitment to compliance to workforce members and constituents and taking other appropriate steps to help prevent, detect and timely redress health care fraud exposures within their organization and to position their organization to respond and defend against potential investigations or charges.

For More Information Or Assistance

If you need assistance reviewing or responding to these or other health care related risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer, may be able to help. Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 23 years experience advising health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients to establish and administer compliance and risk management policies and to respond to DEA and other health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns including a number of programs and publications on OCR Civil Rights rules and enforcement actions. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile here. For important information concerning this communication click here.

About Solutions Law Press

Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources including:

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile here. For important information concerning this communication click here. 

THE FOLLOWING DISCLAIMER IS INCLUDED TO COMPLY WITH AND IN RESPONSE TO U.S. TREASURY DEPARTMENT CIRCULAR 230 REGULATIONS.  ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, OR (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.

 

©2011 Cynthia Marcotte Stamer, P.C.  Non-exclusive license to republish granted to Solutions Law Press.  All other rights reserved.


4th Circuit Rejects Affordable Care Act Constitutional Challenges In 2 Suits

September 8, 2011

The Fourth Circuit this morning (September 8, 2011) published decisions ruled rejecting two lawsuits challenging the constitutionality of the Patient Protection and Affordable Care Act on jurisdictional grounds in Liberty University v. Geithner and Commonwealth of Virgina v. Sebelius.

These decisions add to the growing differences of opinions about the Constitutionality of the Affordable Care Act among the various trial and appeals courts.    These disparities make it increasingly likely that the Supreme Court eventually will decide the issue.  Absent unforsee circumstances, however, any Supreme Court resolution is unlikely to come before the next round of health plan and exchange deadlines start taking effect in 2012 and the lack of agreement among the courts means that most health care providers and others impacted by the Affordable Care Act must continue to plan and comply absent new rulings or other guidance to the contrary. 

If you have about the decisions or other questions about Affordable Care Act or other health care, health plan or related matters, please contact the author, Cynthia Marcotte Stamer at cstamer@solutionslawyer.net or (469) 767-8872.


Unions Get New Tool As NLRB Changes Bargaing Units Certification Rules For Non-Acute Health Care Facilities

September 1, 2011

Non-acute health care facility employers take note.  The National Labor Relations Board has changed its approach for deciding what makes up an appropriate bargaining unit in nursing homes and other health care facilities which are not acute care hospitals. In addition, the Board clarified the criteria used in cases where a party argues that a proposed bargaining unit is inappropriate because it excludes certain employees for health care employees in these facilities.  The newly announced position comes as unions feeling empowered by the union support of the Obama Administration increasingly are stepping up their organizing, bargaining, regulatory and other muscles against health industry and other employers.  Non-acute health care facility and other health industry employers should take steps to manage these rising exposures.

Announcing the policy shift in its 3-to-1 decision in Specialty Healthcare and Rehabilitation Center of Mobile, the Board ruled that Certified Nursing Assistants (CNAs) at a nursing home may form an appropriate unit without including all other nonprofessional employees. The finding overrules the Board’s 1991 decision in Park Manor, which had adopted a special test for bargaining unit determinations in nursing homes, rehabilitation centers, and other non-acute health care facilities.

Under the new criteria for deciding when healthcare workers in facilities other than acute care hospitals constitute an appropriate bargaining unit, employees at such facilities will now be subject to the same “community-of-interest” standard that the Board has traditionally applied at other workplaces. The Board majority found that the 53 CNAs who sought an election in Specialty Healthcare constituted an appropriate unit, and remanded the case to the region to schedule an election.

In explaining its position change, the majority – Chairman Wilma B. Liebman and Members Craig Becker and Mark Gaston Pearce – wrote “We have concluded that the Park Manor approach to determining if a proposed bargaining unit in a nursing home is an appropriate unit has become obsolete, is not consistent with our statutory charge, and has not provided clear guidance to interested parties or the Board,”.

The decision also clarified that where an employer argues that a proposed unit inappropriately excludes certain employees, the employer will be required to prove that the excluded employees share “an overwhelming community of interest” with employees in the proposed unit.  The Board majority write that test is drawn from Board precedent endorsed by the United States Court of Appeals for the District of Columbia Circuit, the decision noted.

Not all of the members of the Board agree with the new position.  In dissent, Member Brian Hayes stated that he would adhere to Park Manor. “which established a balanced legal standard maintained in non-acute care health care unit cases without controversy for 20 years (and without any objection from the party seeking review in this case).” 

He also disagreed that the majority’s statement of the community of interest test was consistent with precedent.  In his view, “the majority accepts as the definitive standard for unit determinations in all industries an ‘overwhelming community of interest’ test that will make the relationship between petitioned-for unit employees and excluded co-workers irrelevant in all but the most exceptional circumstances. The wording of the test may be different, but in practical effect this is the standard espoused by the dissent and rejected by a Board majority in Wheeling Island Gaming, Inc. [355 NLRB No. 127 (2010)].”

Encouraged by the strong union support of the Obama Administration, unions increasingly are testing health industry and other employers.  The Obama Administration has made pro-union legislation and regulation a priority.   While health care and budget concerns thus far have slowed efforts by the Administration and Democratic Party supporters in Congress to adopt many legislative proposals intended to strengthen union power, the Administration is using its appointments to the National Labor Relations Board and regulatory and enforcement powers to support unions in other ways.  This Administration support coupled with a series of recent National Labor Relations Board and court decisions extending protections both to union workers and those employees engaged in traditional organizing activities, as well as to unorganized workers in the context of certain disciplinary or other common workplace contexts are creating new responsibilities and challenges for employers in recognizing and managing liabilities arising under the National Labor Relations Act and other federal labor laws.  Health industry and other employers should familiarize themselves with these changing standards and update their policies, practices and management training to promote their labor-management goals and avoid unintentionally triggering liability by violating these evolving standards.

For Help With Compliance, Investigations Or Other Needs

If you need help monitoring these or other labor-management relations, or other human resources, health care or related concerns developments, or to review or respond to these or other health care related risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer, may be able to help. Board Certified in Labor and Employment Law by the Texas Board of Legal Specialization, Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 23 years experience advising health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health industry clients and other businesses with labor-management, human resources, medical staff and peer review and other workforce matters, as well as a broad range of other health industry risk management and compliance concern as well as helping health industry claims with investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns/ She also regularly designs and presents risk management, compliance and other training for health care providers, professional associations and others including highly popular programs on “Sex Drugs & Rock ‘N Role: Managing Personal Misconduct in Health Care,” “Managing Physician Performance” and others..   Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

About Solutions Law Press

Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources including:

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THE FOLLOWING DISCLAIMER IS INCLUDED TO COMPLY WITH AND IN RESPONSE TO U.S. TREASURY DEPARTMENT CIRCULAR 230 REGULATIONS.  ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, OR (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.

©2011 Cynthia Marcotte Stamer, P.C.  Non-exclusive license to republish granted to Solutions Law Press.  All other rights reserved.

 


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