On May 3rd, 2018, Governor Nathan Deal signed into law SB 370. Under SB 370, which was passed by both chambers of the legislature, the first $25,000 of any Medicaid recipient’s estate is exempted from collection as part of the State’s Medicaid recovery process. Under the current recovery scheme, only those estates valued at less than $25,000 qualified for an unreasonable/substantial hardship exemption and were not subject to collection by the state Department of Community Health. However, all recipient’s estates valued over $25,000 were automatically subject to recovery, and could be completely wiped out by the recipient’s outstanding Medicaid bills. Pursuant to SB 370, the State is now attempting to correct this inequity, and allow all estates to be treated equally. The bill is still subject to final approval by the U.S. Dept. Of Health and Human Services Centers for Medicare and Medicaid Services, and requires the Dept. of Community Health to submit a request for such approval no later than July 1, 2018.
In U.S. ex rel Groat v. Boston Heart Diagnostics Corp (D.D.C. Dec. 11, 2017)., the D.C. District Court granted a motion for reconsideration of its June 2017 decision which held that clinical laboratories were responsible for determining medical necessity. In the new Order, the Court relied on longstanding OIG guidance and clarified that a laboratory cannot and is not required to determine medical necessity, and is allowed to rely on an ordering physician's determination of medical necessity in its requests for government reimbursement.
The Court further explained that although it previously overstated the obligation of a laboratory to make independent decisions regarding medical necessity, a duty still exist for laboratories to ensure that they do not submit claims for medically unnecessary tests.
The Office of Civil Rights entered into a settlement with a small non-profit provider because the provider could not produce a written business associate agreement with a vendor using protected health information. The settlement requires the children's GI center to pay a $31,000 in addition to costly corrective actions. There are two (2) lessons here: (1) all providers should ensure business associate agreements are in place with vendors using PHI and (2) contract management systems are vital. If you have any concerns about your organization's compliance with the HIPAA Privacy or Security Rule, please contact us.
The settlement can be found here.
In U.S. ex rel Ruckh v. Salus Rehab et al, a Florida jury awarded the Federal and Florida governments 115 million in actual and treble damages under a False Claim Act case against the operators of 53 Skilled Nursing Facilities. The allegations at the heart of the case involved either billing for services not rendered and/or services that were not medically necessary.
Memorial Healthcare System, a 6 hospital non-profit system in South Florida, agreed to pay the Department of Health and Human Services $5.5 million to settle potential HIPAA Privacy & Security Rules.
The settlement followed a HHS investigation finding that: (i) MHS disclosed the Protected Health Information of 80,000 individuals in violation of the Privacy Rule and (ii) MHS failed to implement security procedures as required by the Security Rule.
This settlement is another reminder of the importance of health care providers and institutions implementing the administrative, physical and technical safeguards of the HIPAA Security Rule.
Walters Law congratulates attorney Adam Walters on the publication of his article "Caught in the Crosshairs: Physician Liability for Prescription Opioid Abuse" in the American Health Lawyers Association Physician Organization's February Newsletter. For a copy of the article, please email email@example.com