Georgia's Trusted Healthcare
& Medical Provider Attorneys

Archives for June 2013

Jeyaram & Associates to Host Free Legal Seminars: Healthcare, Corporate, Administrative and Education Law

Jeyaram & Associates Free Legal SeminarsTell us what you want!

We’re putting together a schedule of *free* legal seminars hosted by Jeyaram & Associates for this fall, and we want to hear what you want you want to learn about!

Past seminars have included:
* “How to Prepare for a Payor Audit”
* “The Do’s and Dont’s of Physician Contracts”
* “Recovery Audit Contractor (RAC) Appeals”
* “Tips on How to Prepare for an IEP”

….and more

But we want to know what’s on your mind and what you need!

We’ll send invites later this summer for the free seminars.

Let us know your healthcare, corporate, administrative, and legal education needs!

Is it O.K. to Waive Medicare and Medicaid Beneficiary Co-Pays?

AntiKickback Medicaid MedicareThe answer is sometimes.  However, providers must be very careful to consider the implications of waiving beneficiary co-pays.  Primarily, waiving co-pays may trigger The Anti-Kickback Statute.

The Anti-Kickback Statute provides in relevant part:

Whoever knowingly and willfully offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly…, in cash or in kind, to any person to induce such person to refer an individual [for] any item or service for which payment may be made … under a Federal health care program, … shall be guilty of a felony.42 U.S.C. § 1320a-7b(b).

Basically, the statute prohibits giving anything of value in order to induce referrals for business covered by Medicaid and other federally funded health care programs, and may apply to any transaction between providers and program beneficiaries.

However, the statue does not apply if a health care provider acts without any intent to induce improper referrals. In addition, the provider must know about the law, and act “with the specific intent to violate the law.” Hanlester Network v. Shalala, 51 F.3d 1390 (9th Cir. 1995).

Thus, actions taken in good faith for the benefit of patients or program beneficiaries without any improper intent to generate referrals or violate the law do not implicate Anti-Kickback.

The Department may examine any transaction that could generate improper referrals, especially those in which a provider offers free or discounted items or services to program beneficiaries, or those that would otherwise promote over-utilization or create a risk of fraudulent claims. See OIG Special Advisory Bulletin, Offering Gifts and Other Inducements to Beneficiaries (8/02).

Copays and deductibles help discourage unnecessary services and lower the cost of government programs. A provider’s routine waiver of copays and deductibles may create an incentive to over-utilize program resources and violate the Anti-Kickback Statute. See OIG Special Fraud Alert (12/94).

The OIG has set out some safe harbor guidelines.  Waiving Medicaid and Medicare copays or deductibles does not violate the Anti-Kickback Statute if:

  • the waiver is not offered as part of any advertisement or solicitation;
  • the provider does not routinely waive coinsurance or deductibles; and
  • the provider waives the coinsurance and deductibles after determining in good faith that the individual is in financial need or reasonable collection efforts have failed.

The beneficiary’s “financial need” will depend on the individual’s circumstances.  Providers should have a written policy and guidelines in place showing consideration of factors such as the local cost of living, the patient’s income, assets and expenses, and the scope and extent of the patient’s medical bills. The documentation of financial need should be placed in that patient’s file to prove that the analysis was undertaken and the policy was followed.  In addition, collection should always be attempted.

By taking these factors into consideration, a Provider may greatly reduce the risk of being flagged for fraudulent waiver of copays.

For more information, contact DJ Jeyaram at DJ@Jeylaw.com or  678.325.3872.

DCH and GaHIN Launch GeorgiaDirect to Automate Healthcare Referrals

GeorgiaDirectThis week,  the Health Information Technology Division (Health IT) of the Georgia Department of Community Health and the Georgia Health Information Network Inc. (GaHIN) launched GeorgiDirect, a free, secure e-mail, and easy-to use messaging service to automate health care referrals between patients, physicians, hospitals, laboratories and other authorized healthcare stakeholders.

The goal of GeorgiaDirect is to “better serve patients and increase efficiencies in health care across Georgia,” said former DCH Commission David A. Cook. Cook also stated, “This network – which should not be confused with a health insurance exchange – will literally transform health care in the years to come, delivering on our goal of a healthy Georgia through greater coordination of care, delivering better health outcomes, increasing administrative efficiencies and more. Additionally, privacy of health information is paramount to the department, and GeorgiaDirect is much more secure for the transmission of information than current methods.”

The more than 2,100 healthcare providers across Georgia who have registered for the free service are able transmit patient health information between authorized providers for a more efficient and secure exchange of patient data versus the current system of faxes, mail, couriers and telephones.

According to a press release by DCH, “GeorgiaDirect was developed using national standards from the Office of the National Coordinator for Health Information Technology’s Direct Project.” GeorgiaDirect also enables healthcare providers to connect with other states, including Alabama, Florida, Hawaii, Mississippi and Wisconsin. The goal is for GeorgiaDirect to expand and include more states so providers can obtain medical records when patients move to another part the country.

To learn more about GeorgiaDirect, you can watch this video or visit the GeorgiaDirect Web site.