Georgia's Trusted Healthcare
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Not Sure Who Should Be Your Child’s Guardian? Here Are Some Tips

Guardian, Special Needs Trusts, Attorney, Atlanta, GA Recently a family came in for a special needs trust consult and they were at a loss as to whom they should designate as their child’s guardian.

Although the wife had two sisters, neither of them lived close by; nor took an interest in their intellectually disabled niece. The husband also had a sister, but she didn’t have any children – and never wanted any.

Although both of the couple’s parents were eager to be guardians, the parents were of advanced age and in poor health. And as for extended relatives, well, they were extended and didn’t have any meaningful contact with their family.

It’s OK If The Guardian Is NOT Biologically Related

This scenario is more frequent than may you think. We often talk with families who do not have any biological family that can or want to serve as their special needs child’s guardian. And that’s OK.

You don’t want to designate individuals as guardians if they don’t want to be or do not have a meaningful relationship with your child.

“Our Chosen Family”

One of the things that my wife and I have learned through the years (and being in a similar situation as the couple that came to my office) is that you create what we call “Our Chosen Family.”

Our Chosen Family consists of people who WANT to be a part of our lives and enjoy spending time not only with us, but our special needs son. These are people who we’ve come to trust and love us as if they were our own biological family – and it’s these same people who we have chosen to be our children’s guardians.

Something to consider is that by taking the pressure off of your biological family, this may encourage them to remain engaged with your child. Many times biological family members want to help, but may not be in a position to assume guardianship.

Just because you do not choose someone as guardian, does not mean that they cannot be involved in your child’s life and/or be of assistance to the guardian.

There are several ways to keep non-guardians involved including informal roles like “God-parent” or more formal structures like Micro-Boards.

Things to Consider When Choosing A Guardian

When considering who to chose as your child’s guardian, here are some things to consider:

  • Does the potential guardian have a meaningful relationship with your child?
  • Would your child need to move to live with the guardian? How would this impact your child’s therapies or education?
  • Does the potential guardian have the energy and health to take care of your child?
  • Are they trustworthy and responsible?
  • Would the potential guardian continue to care for your child in a way that you want?
  • Most importantly, do they WANT to be a part of your family and be your child’s caregiver if something were to happen to you?

Also, something to keep in mind is that NO ONE will ever care for your child like you do. So it’s important to keep this in mind and be realistic when selecting a guardian.

We hope that our child will never need a guardian, but if they do, this person will need to quickly step in and make sure your child receives the love and care they need.

We Can Help You Decide

The story of the couple that came into my office has a happy ending.

After talking with them about their “Chosen Family,” the answer as to whom should be their daughter’s guardian was much easier and the person they selected gave them great peace of mind.

So even though the guardian they selected was not biologically related, the guardian was their “Chosen Family.”

If you’re struggling with who to designate as a guardian for your child, we can help. I can be reached at DJ@JeyLaw.com and 678.325.3872.

#SpecialNeedsTrusts #Guardians #ChosenFamily

Doctors & Medical Professionals: Here’s How To Respond To Search Warrants

Search Warrants Can Be Scary – Here’s How To Respond

Search Warrant Audit Physician Doctor Attorney Lawyer Jeyaram & Associates“Knock. Knock.”

“Who’s there?”

“The Government. And here is a search warrant.”

Sadly, this is no joke and many doctors and healthcare providers will be served with warrants this year.

Warrants can mean anything from audits to criminal activity and have serious consequences including putting your practice out of business.

Step-By-Step Response To Search Warrants

If the government shows up at your door with a search warrant, the following are some important steps to follow:

  • Immediately call your attorney. It is crucial to call an attorney who has experience in both healthcare law and 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 affidavits 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.

Contact Experienced Legal Help Immediately

It’s imperative to follow these steps. But if nothing else, immediately contact an attorney and he/she will help guide you through the process.

Jeyaram & Associates has helped hundreds of providers successfully handle government investigations. Contact DJ Jeyaram at DJ@JeyLaw.com or 678.325.3872.

Healthcare Providers Need To Ensure Compliance Under Expansion of False Claims Act

False Claims Act Attorney The U.S. Supreme Court voted unanimously to allow False Claims Act (FCA) liability under the “implied certification theory.”

The implied certification theory means that submitting a claim to the government implies that the entity has complied with all contractual and regulatory requirements.

What The Supreme Court Ruling Means To Healthcare Providers

This decision could have profound repercussions for healthcare providers who bill federal healthcare programs. Healthcare providers must contend with the Stark Law and Anti-Kickback Statute (“AKS”). Violations of either the Stark law or AKS give rise to FCA liability. Healthcare cases make up approximately two-thirds of federal whistle-blower cases, which are enforced using the FCA.

The Supreme Court did not limit liability under the implied certification theory to conditions of payment. This ruling can potentially mean that a facially valid invoice can violate the false claims act case because of requirements that are not explicitly requirements for payment. If a regulation is a condition of participation but not a condition of payment, a violation can still give rise to FCA liability.

The Supreme Court did rule that liability is limited to “material” violations. Materiality may be shown if it is a provision for which the government routinely denies payment. The Court emphasized that the materiality test is “rigorous” and demanding….”

Healthcare Providers Need To Ensure Compliance 

Healthcare providers, and all contractors billing the government, should ensure they are compliant with all statutory, regulatory and contractual requirements.

Jeyaram & Associates’ attorneys have extensive experience in helping healthcare providers remain compliant with all state and federal regulations. Contact DJ Jeyaram at DJ@JeyLaw.com or Jonathan Anderson at Janderson@JeyLaw.com.

Healthcare Providers: Are You Compliant With The New Overtime Rule?

Over time healthcare providerThe U.S. Department of Labor recently announced a Final Rule that substantially increases the number of salaried workers who will receive overtime.

The new rule, which goes into effect on December 1, 2016, is expected to affect 4.2 million workers – including healthcare employees.

Currently, employers did not have to pay overtime to salaried workers earning more than $23,600. The new Final Rule increases that threshold to $47,476 with automatic future increases.

The Final Rule will particularly affect healthcare businesses and professionals. The average salaries for nurses, medical and physical therapists, medical and pharmacy technicians, and paramedics is between $25,710 and $47,010. [1]

However, there is some exceptions for certain Medicaid providers. Providers that serve individuals with intellectual and developmental disabilities do not have to increase salaries until March 17, 2019. The delay is for providers of Medicaid-funded services “for individuals with intellectual or developmental disabilities in residential homes and facilities with 15 or fewer beds.”[2]

The delay addresses concerns that the change would increase the cost of paying workers, without the ability to increase the revenue from Medicaid payments.

While the non-enforcement policy is a boon to home and community based providers, it will not affect private pay ID/DD providers. The Administration’s Final Rule is likely to raise costs for those private pay providers because the cost of labor will increase as many more salaried workers are entitled to overtime pay.

Healthcare providers should review their compensation structures to ensure they comply with the new overtime rules. Providers who believe they meet the exception for Medicaid funded ID/DD services should ensure they meet the exception.

Jeyaram & Associates is a full service healthcare law firm and can review employers’ salary structures to ensure compliance with the new law. For assistance, contact DJ at DJ@JeyLaw.com or 678.325.3872.

 

Georgia Department of Community Health Approves $140 million Medicaid Rate Increase

Georgia MedicaidGeorgia doctors, nursing home operators and other healthcare providers will soon see an increase in Medicaid reimbursements. The Georgia Department of Community Health (DCH) approved a reimbursement rate increase earlier this month that will go into effect July 1, 2016.

The increase addresses concerns that low Medicaid reimbursement rates have made it difficult for practices with high volumes of Medicaid patients to be profitable. The rate increases will most likely have the biggest impact on providers in rural Georgia communities, which serve a high Medicaid population. For some providers, the Medicaid reimbursement rate will go up by more than 50% for some procedures.

The rate increases means $140 million in increased reimbursements for Georgia providers. The increase was funded by the General Assembly earlier this year, but the Department of Community Health did not approve the rate increase until the beginning of May. The total will be paid for in part out of the Georgia budget with about two thirds of the increase coming from the federal government.

Jeyaram & Associates is a full service healthcare law firm committed to helping doctors, nurses, hospitals, nursing homes, adult day care facilities, pharmacies, and Medicaid and healthcare providers. Contact DJ at DJ@Jeylaw.com or 678.325.3872.

Healthcare Providers: Your Business Associates Could Cost You Millions

HIPAAHealthcare providers must ensure business associates adequately safeguard private health information

The Department of Health and Human Services (HHS) recently entered into a HIPAA settlement with a Minnesota hospital for $1.5 million because the hospital failed to have a written business associate agreement with one of its contractors.

Business associates are non-covered-HIPAA entities that require access to protected health information (PHI) to perform services for covered entities, often a contractor or subcontractor. The hospital’s policies failed to ensure the business associate adequately protected consumer’s PHI.

While HIPAA applies to certain covered entities, those entities must also ensure that any business associates also adequately secure PHI. HHS found that the Minnesota hospital overlooked two important aspects of the HIPAA rules.

  1. The hospital did not have a written, compliant business associate agreement with one of its IT contractors, and
  2. The hospital failed to have an accurate and thorough risk analysis of its entire IT infrastructure.

HHS investigated after the hospital reported that a laptop was stolen from an employee of the business associate. The laptop contained password protected but unencrypted PHI for almost 10,000 individuals.

The $1.5 million settlement underscores the importance of HIPAA compliance. Healthcare providers must ensure they have compliance agreements with anyone who has access to protected health information. One example of this is when a healthcare provider contracts IT services. Without compliance agreements, companies can be responsible for hefty fines even if a business associate actually causes the PHI security breach.

If you need help creating policies or contracts to protect safeguard private healthcare information, we can help. Please contact Jonathan Anderson at Janderson@JeyLaw.com or 678.325.3872.

Bill Would Eliminate Several Certificate Of Need (CON) Requirements

Certificate of NeedGeorgia House Bill 1055 Would Eliminate “Certificate of Need” (“CON”) Requirements For Several Types Of Healthcare Facilities

Georgia House Bill 1055 would cause a substantial change in the way the state regulates healthcare providers. Georgia’s CON program is administered by the Department of Community Health (DCH). A CON is required for entities before building, acquiring or expanding healthcare services and facilities. Read the full bill here.

Roots of CON Requirements Almost 40 Years Old

Georgia first created its CON program in 1979 in response to the federal “Health Planning Resources Development Act” of 1974. The federal act was later repealed, but many states including Georgia continue to have CON requirements.

The goal of Georgia’s CON program was to “ensure access to quality health care services and to ensure that health care services and facilities are developed in an orderly and economical manner and are made available to all citizens and that only those health care services found to be in the public interest shall be provided in this state.” § 31-6-1. However, since then, the efficacy of CON programs has been questioned, and bills have been introduced seeking to change Georgia’s CON program one way or another nearly every year.

Larger Healthcare Providers Argue CONs Increase Barriers To Expanding

Larger hospitals oppose measures to weaken CON requirements which restrict potential competitors. Hospitals argue they need to use profits from surgical procedures to subsidize less profitable care they are required to provide to the uninsured. On the other hand, physicians and smaller healthcare facilities tend to advocate weakening or eliminating CON requirements because those requirements create barriers to offering services in certain healthcare areas. If House Bill 1055 passes, it would significantly reduce barriers for building multi-specialty surgery centers. Physicians contend changes like this would help lower healthcare costs.

Get Help With CON Requirements

Unless House Bill 1055 passes, Georgia’s CON program will continue to loom large for health care providers of all sizes. At Jeyaram & Associates, we have extensive experience with the CON process and related Letter of Determination and Letter of Non-Reviewability requirements and can help your practice. Contact DJ Jeyaram at DJ@Jeylaw.com  or Jonathan Anderson at Janderson@Jeylaw.com.

 

60 Day Overpayment Questions Answered – CMS Releases Final Rule

Calendar CMSThe Centers for Medicare & Medicaid Services (CMS) published the Final 60 Day Overpayment Rule on Thursday, four years after the initial rule was released.

This Final Rule clarifies application of the 60-day reporting requirements instituted pursuant to the Affordable Care Act. Under the 60-day Overpayment Rule Medicare providers must report and return overpayments within 60 days of when an overpayment is identified (or the cost report due date, when applicable).

Prior to the publication of the Final Rule, there was much speculation, and interpretation by courts as to how to define “Identification.” This definition is important because when an overpayment has been “identified” as provided in the law, the 60 day clock starts ticking and the deadline for reporting and repayment is set.

Key Clarifications On Overpayment

The Final Rule provides a key addition in how “identification” is defined by adding that an overpayment is “identified” after such overpayment has been quantified. The Rule also requires that providers exercise “reasonable diligence,” which according to CMS requires “both proactive compliance activities to monitor claims and reactive investigative activities undertaken in response to receiving credible information about a potential overpayment.”

The Final Rule further clarifies that providers have up to 6 months to investigate a possible billing error before the 60-days start to run. This replaces an indefinite requirement set forth in the Proposed Rule that providers act with “all deliberate speed.”

Another noteworthy change in the Final Rule is the stated “look-back period.” In the Proposed Rule, overpayments had to be reported and returned if a person identified the overpayment within ten years of the date the overpayment was received. However, the Final Rule reduces this time frame to six years. This shortened “look-back period” is likely to reduce the administrative burden of complying with the law.

To review the Final Rule in its entirety it is available at here

Need Help?

If you have questions about the overpayment rules or need assistance, we can help you. Please contact Danielle Hildebrand at dhildebrand@jeylaw.com or 678.325.3872.

 

Jonathan Anderson Joins Jeyaram & Associates

Jonathan AndersonPlease help us welcome Jonathan Anderson to our legal team!

Mr. Anderson is an associate attorney specializing in healthcare law. Prior to joining Jeyaram & Associates, Mr. Anderson worked as a legal intern on the Disability Integration Project for the Atlanta Legal Aid Society.

Mr. Anderson provided legal support to individuals with disabilities to help them remain in or move back the community rather than live in institutions. He also worked extensively with state Medicaid waivers including appealing the State’s decisions to terminate benefits of disabled individuals.

Mr. Anderson also served as an intern for the Health Law Partnership (HeLP) which serves clients whom meet certain income requirements and have a treatment relationship with Children’s Healthcare of Atlanta (CHOA). He conducted interviews, drafted briefs for Supplemental Security Insurance, and researched how changes in Supplemental Security Insurance regulations affected HeLP clients.

Legal Expertise

  • Medicaid Waivers
  • Medicare
  • Mediation

Jonathan can be reached at janderson@jeylaw.com.

“Two Midnight Rule” Clarifies Reimbursements For Hospitals

Hospital ReimbursementIn 2013, the Centers for Medicare and Medicaid Services (CMS) announced the so-called two-midnight rule in an attempt to clarify when a patient should be designated to inpatient status versus outpatient status.

Hospitals are paid differently for treating inpatients versus outpatients. The rule addressed when surgical procedures, diagnostic tests and other treatments are generally considered appropriate for inpatient hospital admission under Medicare Part A.

The two-midnight rule attempts to set a bright line test: only patients that doctors expect to spend two nights in the hospital are considered inpatient.

Although the rule was set to take effect on October 1, 2015, CMS recently announced that it would postpone the enforcement on inpatient status reviews. The rule will now go into effect December 31, 2015.

Additionally, CMS proposed that it will consider stays a physician expects to last less than two midnights to be an inpatient admission relying on the judgment of the physician and the documentation justifying the stay on a case-by-case basis. For many in the healthcare industry, this appears to be a small step in the right direction.

Lastly, CMS announced that it will shift the responsibility of educating physicians and enforcement of the two-midnight rule to quality improvement organizations (QIO) from recovery auditors.

If you have questions about the Two Midnight Rule, please contact Kimberly Sheridan at ksheridan@jeylaw.com or 678-708-4702