Georgia's Trusted Healthcare
& Medical Provider Attorneys

DJ Jeyaram Earns Georgia’s Top Lawyers’ Award – Healthcare & Administrative Law

Healthcare Law AwardPrincipal DJ Jeyaram has achieved the prestigious 2014 peer-reviewed rating of AV Preeminent® by Martindale-Hubbell®. According to Martindale-Hubbell, “The AV Preeminent® Rating is a significant accomplishment and demonstrates that a lawyer’s peers have ranked them at the highest level of professional excellence.” Martindale-Hubbell is the company that has long set the standard for lawyer ratings. DJ earned the award for superior legal service in healthcare and administrative law.

Congratulations DJ Jeyaram!

Healthcare Fraud: What To Do If You’re Audited

healthcare fraudOver the past several years, we’ve seen a trend in increased investigations and enforcement of healthcare fraud. This trend continued in 2013 and is continuing in 2014. Nationally, in 2013, the United States Attorney’s Office investigated 1,013 new criminal matters involving healthcare fraud and filed charges in 480 of these cases. In Georgia, in 2013, there were 336 Medicaid Fraud Investigations.  Of those investigations, only 13 led to indictment; but of those 13 indicted, 10 resulted in convictions. Given this trend, if you are a healthcare provider, it is vital to know what to do if you find yourself being investigated for fraud.   Following are some important  steps to follow if the government shows up at your door with a search warrant: —  Immediately call your attorney. Do not pass go. Call.  It is crucial to call an attorney who has experience in both health care law and in defense. —  Ask for identification of the people at your door. Review the credentials or business card. Write down the name and contact information. —  Do NOT destroy, alter or remove any documents. —  Be polite. Remain calm. Be cooperative. Say please and thank you. —  Ask for a copy of the search warrant and any affidavit filed in support of the warrant. —  Ask what crime and conduct is under investigation. —  Request that no interviews be conducted until your attorney arrives. —  Immediately advise all supervisory personnel of the search and that they are to wait for the attorney to arrive before answering any questions. —  Compile an inventory of all the documents being removed and ask if you can copy all the documents being seized – this includes making a back up disk for all computer files —  Make a record of everything said by an investigating officer. If you cannot do this during the search, write up your recollection after the search —  If possible, videotape or photograph the search —  DO NOT speak with the press Jeyaram & Associates has helped numerous organizations facing charges of healthcare fraud. To learn more or for assistance, contact Kimberly Sheridan at ksheridan@jeylaw.com

More Providers Audited for HIPAA Compliance – Are You Ready?

The number of entities audited for HIPAA compliance has increased. Are you prepared if OCR comes knocking on your door?

Under the HITECH Act, the Department of Health and Human Services is required to conduct periodic audits to ensure that entities are complying with HIPAA. Phase 1 audits concluded in 2012. Now OCR has released information on Phase 2 and more audits are set to begin around October of this year.

HIPAA Covered Entities and Business Associates selected for audits will be asked to quickly produce policies and procedures, executed business associate agreements and other HIPAA-related documentation so that it can be reviewed by OCR to determine if any deficiencies exist. OCR has noted that it intends to focus on the deficiencies identified through Phase 1 audits. These include lack of proper policies and procedures, presence of security risks, failing to conduct a security risk assessment, and failing to have business associate agreements on file.

Small providers should also take note—according to OCR, small providers tended to have more deficiencies than larger providers. OCR has also revealed other details regarding the 2nd audits, OCR will be conducting the audits internally. They have also increased the number of entities to be audited to 400 entities, 350 of which will be Covered Entities and the remaining 50 will be Business Associates. Some of the audits will focus on the Privacy Rule, others on the Breach Notification Rule, and the remainder will focus on compliance with the Security Rule.

If your organization is a covered entity or business associate under HIPAA you want to make sure that you are prepared in case you are one of the entities subject to an audit this Fall. Steps you will want to take include:

  • Have all your HIPAA policies and procedure updated and on file
  • Make sure all your Business Associate Agreements reflect the 2013 changes to the HIPAA Rules and have those agreements properly executed and on file
  • Conduct a security risk assessment if you have not already and ensure that security risks are addressed
  • Engage an experienced healthcare law firm to proactively help you review the aforementioned items to help you identify any potential deficiencies

To view OCR’s Presentation on Phase 2 Audits, click here: OCR Audits Phase 2 by Linda Sanches, Senior Advisor for Health Information 

For more information contact DJ Jeyaram at dj@jeylaw.com or Danielle Hildebrand at dhildebrand@jeylaw.com 

Are YOU Compliant With New HIPAA Rules?

imgres-6It has been half a year since the new HIPAA Rules were fully implemented, are you compliant?

If you are a healthcare provider or work with healthcare providers you should already know that last year the Department of Health and Human Services published the HIPAA Omnibus Rule expanding the reach of HIPAA enforcement and bolstering notification requirements. Under the rule, business associates must comply with most of the requirements that previously only applied to covered entities.

Furthermore, HHS can now impose penalties directly on business associates, which range from $100 to $50,000 per violation.

Covered entities also have new requirements that they must follow. For example, such entities must provide notifications to the affected individuals and to HHS when a breach has occurred. If a large group of individuals are affected the entities must also notify the media. Furthermore, the definition of a breach is more expansive—an impermissible use or disclosure of protected health information (PHI) is presumed to be a “breach,” unless the HIPAA-covered entity demonstrates there is a low probability that the PHI has been compromised.

Entities that deal with protected health information in the form of electronic health records should also be aware that such entities have become an attractive target for hackers. The information in a medical record is extremely valuable on the black market making protected health information of patients susceptible to theft.

Given the new obligations and penalties under the Omnibus Rule and the increasing vulnerability of protected health information it is more important than ever to ensure that the proper measures are in place to prevent breaches. HIPAA-covered entities and business associates need to consider whether they are in a position to protect against and appropriately respond to breaches through periodic risk assessments and implementation of HIPAA-compliant policies and procedures.

Some threshold questions that your entity will want to ask include:

• Do you have a current written HIPAA policy that reflects the practices of the organization?

• Does your HIPAA policy address what is to be done in the event of a breach?

• Does your policy provide a proper means of assessing whether a breach has occurred?

You can view the Omnibus Rule, including the changes to the Privacy Rule, Security Rule and Breach Notification Rule here: HHS.gov – HIPAA Omnibus Rule

Increase in State Funding Needed for Agencies that Provide Care to Developmentally Disabled

United Cerebral PalsyThe State of Georgia has been looking at new rates for agencies who care for the developmentally disabled (like United Cerebral Palsy of Georgia-UCP) for quite some time-years in fact.  The State is finally taking up the issue again and these agencies need help in getting the much needed additional funding.

A rate increase means that these agencies can afford to pay a decent wage to the caregivers and provide enough caregivers in their programs to allow our consumers to live a decent life.

Below are a few points which explain how rates to support those with disabilities have evolved over time and clearly demonstrate the need for an increase.

Why agencies like UCP need additional funding:

DBHDD / DCH FACTS: There has NEVER been a state funded investment in individuals with DD and their community based services since the inception of the Medicaid Waivers to support community based services.

  • 1988 – 89 Waivers began (MRWP)
  • 1997-CHSS Waiver added to support closure of Brookrun
  • 2003-FIRST waiver increase (both MRWP and CHSS) – match derived by eliminating $400 GIA Room and Board supplement.  Increase was 3.4% – NO STATE MONEY WAS INVESTED IN INDIVIDUALS WITH DD.
  • 2007-Legislatively approved 3% rate increase- not implemented in 2008 due to economy shift
  • FY 2014 GIA Contracts $32m unmatched State dollars for Waiver type services (CLS, SE , CRA &CAG/Prevoc)

ECONOMIC FACTS:

  • Consumer Price Index (CPI) has risen 88.3% since 1989
  • Cost of Employee Benefits has risen 146% since 1989
  • Minimum Wage has risen 116.42% in past 20 years ($3.35 1983 to $7.25 2013)

Contact your legislators and tell them that you care about people with disabilities in Georgia.  Attached are sample letters you can use to do that.  This link takes you to a page where you can click use a map to click on your home area/city and it will then tell you who your local legislators are:  http://openstates.org/ga/  (use the plus sign on the map and your mouse to navigate around the state to find your home area/city.)

– – – – – –

Sample Email to Legislator

Dear Representative John Doe  (Dear Senator) :

I want to bring to your attention an issue that is very important to me and I am looking for your support when the Legislative Session begins in January.

I am aware of the work of NAME OF AGENCY in supporting those in my community who have Developmental Disabilities. These citizens of our community need the very best care and support we can provide them. NAME OF AGENCY provides supports and services which are so critical to the well being, health and safety of these individuals, some of Georgia’s most vulnerable citizens.

The individuals relay on a stable and consistent workforce to assure their progress and well being. They relay on the stability of community organizations such as NAME OF AGENCY to assure support and care is consistently available.

The funding for the vital services we provide has not changed in over a decade and this one change is the only adjustment since 1989! I urge you to support a rate adjustment for services and supports for individuals with developmental disabilities. The individuals are relaying on you and so am I, to assure some of Georgia’s most vulnerable citizens have the same quality of life as you, I and other Georgians without disabilities. Please invest in those with Developmental Disabilities.

THANK YOU!

Name, Address, Phone#, email

Media Coverage for Lawsuit Against the State for Severely Disabled

Class Action Lawsuit Against GeorgiaAdditional media coverage on our class action lawsuit against the state for severely disabled:

http://www.dailyreportonline.com/PubArticleDRO.jsp?id=1202614700896&Class_Action_Seeks_State_Funds_Not_Paid_To_Disabled

http://wabe.org/post/lawsuit-alleges-state-underpaid-providers-who-serve-disabled

http://www.cbsatlanta.com/story/23086886/exclusive-lawsuit-filed-against-state-of-georgia-alleges-funds-withheld-for-disabled

Jeyaram & Associates and Parker, Hudson, Rainer & Dobbs File Class Action Law Suit Against the State

Class Action Law Suit Against GeorgiaJeyaram & Associates and Parker, Hudson, Rainer & Dobbs have filed suit against the state for withholding millions of tax funds earmarked for severely disabled individuals.

Family members representing people with severe disabilities and a group of their health care providers today filed a class action law suit against the Georgia Department of Behavioral Health and Developmental Disabilities and the Georgia Department of Community Health for withholding funds that were designated for the care of those individuals contrary to controlling law.

United Cerebral Palsy of Georgia, Inc., Coastal Center for Developmental Services, Inc., Hope Haven of Northeast Georgia and Creative Community Services, Inc. as well as four families representing nearly 12,000 individuals in the State seek the return of hundreds of millions of dollars that should have been used to care for those individuals since 2008.  The exact amount will be determined at trial.

The families filing suit represent clients who depend on vital services from these healthcare providers every single day. These clients are some of the most vulnerable members of our communities.  Their daily lives have been negatively impacted in real and tangible ways, as have those of their families and caregivers.

“My daughter Tammy wants and needs activity.  Sitting in front of a TV set is counterproductive for her,” says Angela Tulloh of Kennesaw.

Marilyn Harvill worries about the ongoing and future care of her son, 53 year old Matt Windham.  “Matt has severe brain damage and needs 24 hour one-on-one care.  I am worried about the services Matt will receive in the future because I wasn’t given any notice of the cuts.”

None of the families affected was notified by the state of the pending cuts and none was given any recourse.

Additionally, an undetermined number of other individuals requiring new services have been turned away due to the improper budget cuts.

Those organizations filing suit are designated Medicaid providers. The two state agencies being sued have failed to reimburse the plaintiffs for services provided under contract to clients with profound intellectual and developmental disabilities. That has led to severe financial harm to these providers. The state has very specific rules and procedures it must follow before reducing already agreed upon payments to providers and families.  None of those procedures has been followed.

These cuts in Medicaid funds were not tied to the recent economic downturn; rather the funds were allocated by the state legislature and simply not paid in full to the providers and clients who depend on them.

“We have gone through our financial resources to keep serving our existing clients, but we have had to turn away other people with severe developmental, medical and behavioral needs.  I don’t know what happens to those people,” says Sally Buchanan, CEO of Creative Community Services of Norcross.

Curt Harrison, Associate Executive Director of United Cerebral Palsy Georgia and South Carolina, says

“So many people rely on us and we’re doing the best we can.  But development of new services and additional employee training have really suffered.  However, we don’t think it’s morally appropriate to cut services.”

 To view this story on Channel 46: http://www.cbsatlanta.com/story/23086886/exclusive-lawsuit-filed-against-state-of-georgia-alleges-funds-withheld-for-disabled

Georgia to Hire Private For Profit Company to Oversee Medical Care of Foster Children

Streamlined Managed CareThe state is planning to streamline the medical care of children in foster care, adoption assistance or the juvenile justice system by transitioning to a managed care model.

Currently, the change in the living situation of these children may result in a change in doctors and incomplete medical records, which can ultimately result in complications when doctors are not aware of medical history or allergies.

Under the managed care model, the children will have one primary care physician and their records will be stored electronically, allowing for continuity of care and access to information regardless of where the child is living.

In addition to potentially saving the state $27.5 million over five years, the move to managed care may result in healthier children. Other states using the managed care model for foster children have reported decreases in the use of psychotropic medication and increases in health risk screenings.

Georgia plans to hire one of the three for-profit care management organizations in the state that currently oversee the provision of care to children and pregnant women who receive Medicaid.

Further, a quarterly oversight committee will be established that is comprised of representatives from several agencies to monitor the progress under the managed care model.

The managed care model for children in foster care, adoption assistance or the juvenile justice system may potentially provide less confusion for physicians and a greater continuity of care for children.

Medicare Trustees Report Includes Promising News for Healthcare Providers and Beneficiaries

Healthcare Cost SavingsThe Medicare Trustees recently released their 2013 Report, and it contained some promising news for the Medicare Hospital Insurance Trust Fund.  The Fund will be able to cover its obligations until 2026, which is an extension of last year’s projection by two years.

The increased solvency of the Trust Fund is good news for both healthcare providers and beneficiaries because it points to the positive financial impacts of current efforts to reduce healthcare spending.  Additional good news for beneficiaries included a preliminary estimate of the Part B premium for 2014, which is unchanged from 2013.

The CMS Administrator attributes the increased solvency of the Trust Fund to the Affordable Care Act; however, the Report cites numerous contributing factors, such as lower 2012 Part A spending and potentially lower Medicare Advantage costs.

Opponents of health care reform stress that crediting the Affordable Care Act for the increase in solvency may be premature because the numbers depend on a range of factors, none of which are fully predictable at this stage of implementation.

The actual impact of the Affordable Care Act provisions remains to be seen as does the implications to the Trust Fund.  Providers should stay informed about the potential financial impacts of healthcare reform as provisions are implemented in the coming months.

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!