Georgia's Trusted Healthcare
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Archives for August 2015

Medicare & Medicaid Deadline For Overpayment Clarified

60 Days Medicaid and Medicare RuleFederal Court Finds Sixty Day Rule Deadline Begins to Run When Put on Notice of Potential Overpayments

When the Affordable Care Act (ACA) was passed, a new requirement for reporting overpayments was created. This new obligation, often referred to as the ‘Sixty Day Rule’ requires providers who receive an overpayment of Medicare or Medicaid funds to “report and return” the overpayment to the government.

According to the statute, an overpayment must be reported and returned within sixty days of the “date on which the overpayment was identified.” Failing to do so is a violation of the False Claims Act.

Although Centers for Medicare and Medicaid Services (CMS) has provided some guidance on when an overpayment is “identified” within the context of Medicare, now a New York Federal Court has weighed in on the meaning and application of the ACA sixty-day rule as it applies to Medicaid.

In a case before a New York Federal Court, the U.S. Department of Justice asserted that a hospital improperly billed Medicaid in 2009 and 2010 and violated the FCA by delaying the return of overpayments. Such overpayments were the result of a billing system software glitch. The case was brought with the assistance of a former employee who had investigated the issue. Such employee had provided to hospital administrators a list of around 900 claims that were likely affected by the glitch which was subsequently ignored by the hospital.

The Court had to decide how to define the key term in the statute – “identified.” In the case, the former employee had not conclusively proven the identity of any overpayments. As it turned out, hundreds of the claims he listed had not actually been overpaid. However, he did recognize nearly five hundred claims that did in fact turn out to be overpaid as worthy of attention.

After looking at the legislative history and purpose, the Court concluded that the 60-day clock begins ticking when a provider is put on notice of a potential overpayment, rather than when the overpayment is conclusively ascertained. This holding is in line with CMS’s patchwork of guidance for Medicare overpayments.

As a result, providers facing a potential overpayment must take action immediately to meet the 60 day deadline and avoid False Claims liability. Every health care practice should have a protocol in place to ensure that possible overpayments are investigated in a timely manner and such investigation is documented appropriately. Failure to report overpayments within that time frame could subject providers to huge penalties.  

If you have any questions about the 60-day rule or need assistance with investigating and reporting a potential overpayment contact Danielle Hildebrand at dhildebrand@jeylaw.com.

Free Introductory Home Health Visits Don’t Violate Anti-Kickback Law

Anti-Kickback StatuteInspector General: No Kickback violation for free home health introductory visits

The Office of the Inspector General issued an advisory opinion clearing the way for home health providers who provide “introductory” home visits to individuals who eventually become their clients. The OIG advised that home healthcare providers who contact  patients after being selected by that patient and provide information to those patients about their services, do not violate the federal Anti-Kickback statute.

The Federal Anti-Kickback law makes it a criminal offense to knowingly and willfully offer, pay, solicit or receive anything of value in exchange for inducing or rewarding referrals of items or services reimbursable by a Federal health program

The OIG’s office stated that the “primary purpose of the Introductory Visit is to facilitate the patient’s transition to home health services in an effort to increase compliance with the post-acute treatment plan.” In addition, the OIG”s noted that during the “Introductory” visit, the health care provider ‘”does not provide any type of  any federally reimbursable diagnostic or therapeutic services during the Introductory Visits,” which occur where a patient is receiving care whether it’s a physician’s office, hospital or personal home. Further, the home health provider is not involved in any way in the patient’s selection process and “Introductory Visits” do not provide any actual or economic benefit to the patients. .

It’s important to reiterate, that healthcare providers should not contact the patient prior to receiving notification from the  patient that they have been selected nor can the “Introductory Visits” be a covered service under Medicare or Medicaid, or reimbursed by third-party payors. These actions could violate the Anti-Kickback statute.

To read the full opinion, click here.

For more information, please contact Kimberly Sheridan at 678-708-4703.

RSVP For Free Legal Workshop: Katie Beckett/Deeming Waiver Appeal & Special Needs Trusts

IEP Education LawTwo Things Every Special Needs Parent Should Know

1. How to Win A Katie Beckett Appeal: A presentation on how to appeal a Katie Beckett denial. Almost all applications are initially denied. Learn how to prepare and what to expect – and when to engage a lawyer.

2. Protecting Benefits With Special Needs Trusts: Learn the basics on what a special needs trust is and how it works. We’ll also talk about the ABLE Act and how it works with a special needs trust.

  • When Friday, September 11 at 10:00 am to 11:30 am
  • Where: FOCUS main office | 3825 Presidential Parkway, Suite 103 – Atlanta, Georgia 30340
  • Who : DJ Jeyaram, Esq. – attorney and special needs parent

Please RSVP to Elizabeth@focus-ga.org with your name and the word “Trust” in the subject line by September 1st.

About FOCUS

FOCUS offers comfort, hope, and fun to families with children who are medically fragile or have significant developmental or physical disabilities through a variety of programs. http://www.focus-ga.org/

 

 

 

Without A Will, A Court Could Decide Custody Of Your Child

wills, Trusts and Estates10 Tips On Choosing The Right Guardian

Sadly, during the past couple of weeks, we learned of the passing of several friends and acquaintances. All of their passings were sudden. A heart attack. A car accident. A sudden mystery illness. An aneurism. To be honest, we became a bit leery about answering our phones.

Death isn’t something we like to think about, let alone talk about. However, these past few weeks were a stark reminder of how important it is to make sure we prepare for the future and to make sure our families are protected – especially if you have minor children.

We often assume that a member of our family – maybe a sister or our own mother – will automatically be given custody of our children if something happens to us. However, this is not true unless you have a will, trust or estate plan in place that specifically names them as guardians. Without a legal plan in place, anyone can request custody and a judge will decide with whom your child/children will live with.

As a result, it’s imperative to establish a will and choose a guardian for your child.

Following are some things to consider when choosing the right guardian:

  1. Age – How old is the person you’re considering to assume custody of your child if you pass? You want to make sure the potential guardian will be around for a while to raise your child.
  1. Ability – How is the health of the potential guardian? Does he/she need a lot of medical care? Is he/she emotionally stable? How many other children does the potential guardian already care for? Does he/she have a demanding job or a job that requires him/her to frequently travel? You wan to select someone who is going to be physically present and give your child the attention he/she needs – especially since your child will already be dealing with loss and grieving.
  1. Already established relationship with your child – Does the potential guardian already know your child and have an established relationship with him/her? Imagine being forced to live with someone you don’t know. Add on the stress of losing a parent. It’s imperative that your child know and be comfortable with the potential guardian.
  1. Location – Where does the potential guardian live? Is this somewhere you’d want your child to live? If you currently live in the city and your potential guardian lives in a small, remote town – would your child be happy and thrive? Does the potential guardian live in a good school district or are there good private schools nearby?
  1. Family values – Finding a potential guardian with the same family values can be challenging – but it’s perhaps one of the most important criteria to consider. Is this individual willing to instill and be supportive of your family values – especially if they do not mirror yours?
  1. Parenting style – Does the potential guardian believe in time outs? Is education important? Is the potential guardian strict or nurturing? You’ll want to choose someone who reflects your parenting style to minimize the stress and confusion on your child.
  1. Stable and loving – Selecting a guardian who can provide a stable environment for your child is critical – especially as your child will be grieving. Your child will look to the guardian for emotional and physical stability. Is the guardian in a stable relationship? Is his/her spouse open to being a guardian as well?
  1. Willing and want to serve as guardian – Taking on custody is a big responsibility. While some family members may love your child – assuming custody and providing for his/her every need is a different story. It’s important to have open and honest conversations about potential guardians to see if they want to serve as a potential guardian. Now is NOT the time to try and avoid hurt feelings. Your child’s well being and future is what’s most important.
  1. Character – Does your potential guardian have a court record of drug or alcohol abuse or a criminal history? If so, a court will reject and override your selected guardian. You want to select someone who will serve as a good role model for your child.
  1. Back up – Life happens. Your designated guardian may become incapacitated or have a change of heart upon your passing. It’s critical to have a back up potential guardian to ensure your child has a safe, loving and stable home.

It’s important to remember that a guardian is NOT required to financially support your child. As a result, it’s important when you’re setting up your will, trust or estate, to legally earmark funds for your child in a trust. Then, you will need to select an individual to oversee the disbursement of the money in the trust. This person is called a trustee. Often times, the trustee is different from your child’s guardian.

Selecting a guardian for your child can be a difficult decision – but it’s an important one. By legally documenting your wishes for your child/children, you help ensure that your loved ones are cared for and that a custody battle does not publicly play out in court.

Once you’ve carefully thought about and chosen a guardian for your child, we encourage you to consult with an attorney to help document your decision so that it becomes legally binding.

If you have questions or would like assistance, please contact DJ Jeyaram at DJ@Jeylaw.com or 678.325.3872

Avoid Being A Target Of HIPAA Audits | Here’s How

HIPAA AuditPhase 2 OCR HIPAA Audits Are Here – What Providers Should Do to Prepare

The Office of Civil Rights (OCR) has taken the first step in the next round of HIPAA audits.

OCR has begun to send out surveys in order to collect information from providers, health plans, and clearinghouses in preparation for phase 2 of their HIPAA audits. From the hundreds of entities receiving surveys, OCR will select over 200 providers and over 100 health plans to be audited.

It is more important than ever to make sure that you have complied with the HIPAA Rules. Here are the top 3 areas every provider should address:

1. When was the last time you conducted a Risk Assessment? If it has been more than a year or two, you should conduct a comprehensive Risk Assessment now.

If you are a small to medium sized office you can take advantage of HHS’s security risk assessment tool available on their website: HHS.gov SRA Tool

2. Have you recently reviewed your HIPAA policies and procedures to ensure that they are up to date and are being followed? There are three main areas that need to be addressed in your policies: Security Standards, Privacy Standards and Breach Notification Standards.

    • Security Standards – focus on how you keep Protected Health Information (PHI) secure, whether it is stored and/transmitted electronically or in some other form. Your practice must have appropriate safeguards in place (for example, requiring the use of secure passwords to access electronic health records and encrypting all devices that might contain e-PHI).
    • Privacy Standards – do you conduct periodic trainings for personnel regarding privacy practices? Do you have records that such trainings have been completed by all personnel? Is your Notice of Privacy Practices current and made available to your patients?
    • Breach Notification Standards – do you have a policy in place that outlines the steps for identifying and reporting a breach? Such a policy should address steps to take to investigate and contain the problem, as well as a means for identifying how many people were affected, who those individuals are, and how to send out breach notices. Keep in mind that under the Breach Notification Rule, providers must provide notice of a breach within a certain time frame. Your procedures for responding to a breach should allow for adequate time to meet this deadline.

3. Keeping track of your Business Associates and Business Associate Agreements – During the audit process OCR might ask for a list of business associates and their contact information. All providers should have this readily available. It is also important to have written Business Associate Agreements that are up to date and can be made available to OCR upon request.

If you have any questions about any HIPAA requirements or the approaching OCR audits our attorneys can help. Please contact Danielle Hildebrand at dhildebrand@jeylaw.com.

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The information on this site should not be construed as formal legal advice and is not intended to create or constitute a lawyer-client relationship.