Archive for the ‘Litigation and Risk Management’ Category

New Vermont laws on abuse, neglect and exploitation of vulnerable adults residing in long term care facilities

Authored By: Sean J. Fahey

Vermont Governor Peter Shumlin recently signed Vermont House Bill 413 into law.  The new law adds a new section to Vermont’s laws on abuse, neglect and exploitation of vulnerable adults residing in long term care facilities.  The new section allows Vermont’s Attorney General the right to pursue a civil action against individuals, nursing homes and other long term care facilities, who, with reckless disregard or with knowledge violate Vermont’s laws abuse, neglect and exploitation of vulnerable adults.   The new law provides that merely having a report filed with the Vermont Attorney General of abuse, neglect, exploitation or suspicion of those acts, is not be sufficient to demonstrate that a person or caregiver acted with reckless disregarded.  Fines start at $5,000 if no bodily injury results and can rise to $50,000 if death occurs.  The new law is effective July 1, 2012.

Vermont’s new law can be found here.
Should you have any questions, please contact:

Todd Selby at 317.977.1440 or tselby@hallrender.com;

Brian Jent at 317.977.1402 or bjent@hallrender.com;

David Bufford at 502.568.9368 or dbufford@hallrender.com; or

Sean Fahey at 317.977.1472 or sfahey@hallrender.com,

or your regular Hall Render attorney.

CMS Releases Final Rule Requiring Providers to Include NPI on Enrollment and Claim Filings

Authored By: David W. Bufford

The Centers for Medicare & Medicaid Services (CMS) just released a final rule requiring all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the Medicare and Medicaid programs.  The final rule will be published in the April 27th Federal Register, and the rule will become effective 60 days after publication, June 26.

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Home Health Agency Patient Surveys Now Available for Consumers

Authored By: David W. Bufford

Consumers can now compare results from home health agencies (HHA) patient surveys on the Quality Care Finder website.  These results are designed to create incentives for HHAs to improve quality of care, as well as to give patients additional information as to the type of care they will receive from a particular agency.  The Centers for Medicare & Medicaid Services (CMS) also states one of the goals of such public reporting is to enhance accountability by increasing transparency.  (more…)

CMS Reverses Course on Requiring Independent Pharmacy Review

Authored By: David W. Bufford

In a surprise reversal, the Centers for Medicare & Medicaid Services (CMS) has dropped a controversial proposed regulation that would require nursing homes to hire independent pharmacists to oversee residents’ medication regimens. 

The proposed rule had been developed in response to the belief that relationships between long-term care providers and pharmacy suppliers could conflict with the best interests of nursing home residents.

In response to overwhelming criticism, CMS has dropped the proposed regulation for now, which they acknowledged would be “highly disruptive to the industry.” Regulators “decided to further study the issue for future policy considerations,” Jonathan Blum, deputy director of the agency, said in a conference call with reporters.

CMS remains concerned about inappropriate medications for nursing home residents, and in a separate statement, encouraged nursing homes to voluntarily adjust how medications are prescribed or face stiffer regulations down the line.

Should you have any questions, please contact:
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.

OIG Posts Video Guidance on Self-Disclosure

Authored By: David W. Bufford

As part of their on-going video series, the Office of Inspector General (OIG) has posted a video on their self-disclosure protocols.

Self-disclosure is a key element of an effective compliance program, and can possibly reduce any civil monetary penalties (CMPs) associated with a violation or instance of noncompliance.

The OIG has provided many videos in this series that are beneficial for long-term care providers.  The full list of videos is available on the OIG Website.

Should you have any questions, please contact:
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.

 

CMS Postpones Two Anti-Fraud Initiatives

Authored By: David W. Bufford

The Centers for Medicare & Medicaid Services (CMS) has pushed back the start of two anti-fraud programs to June due to provider concerns.  Two pilot programs, one that would require prior authorization for scooters and power wheelchairs and one allowing recovery audit contractors (RAC) to review claims prior to payment, were initially slated to begin January 1, 2012.   (more…)

CMS Seeks Savings Through Changes in Medicaid Drug Payments

Authored By: David W. Bufford

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that enacts a provision of the Patient Protection and Affordable Care Act (PPACA) that seeks to make Medicaid reimbursement for medications more transparent and more closely aligned with what pharmacies pay for the drugs.  In a press release, CMS states the rule will save states and taxpayers $17.7 billion on prescription drugs over the next five years.  The regulations would also increase the rebates paid by drug makers that participate in Medicaid and would establish rebates for drugs provided to enrollees in Medicaid managed-care plans.  Comments will be accepted on the proposed rule until April 2, 2012, with a final rule scheduled for 2013.

Should you have any questions, please contact:
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.

Administration Recommends Only Two Sections of PPACA be Overturned if SCOTUS Rules Unconstitutional

Authored By: David W. Bufford

The Department of Justice (DOJ) has recommended to the Supreme Court of the United States (SCOTUS) that only the provisions of the Patient Protection and Affordable Care Act (PPACA) that require insurers to accept everyone regardless of health status and to apply “community rates” be overturned if the Justices rule that the law’s mandate is unconstitutional.   (more…)

CMS Clarifies Guidance on PPACA Mandatory Medicaid Terminations

Authored By: David W. Bufford

The Centers for Medicare & Medicaid Services (CMS) released updated guidance on Section 6501 of the Patient Protection and Affordable Care Act (PPACA) that requires state Medicaid agencies to terminate the participation of any individual or entity if such individual or entity is terminated under Medicare or any other state Medicaid plan.   (more…)

OIG Releases Provider Compliance Videos

Authored By: David W. Bufford

In December, the Office of the Inspector General (OIG) released an initial series of videos aimed at providers that focus on compliance issues.  These videos are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative.  Health & Human Services Inspector General Daniel Levinson stated the videos are intended to help providers further enhance their compliance efforts.  (more…)

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