Tag Archives: Office of the Inspector General

A New Year Means New Audits and Site Visits for Assisted Living Facilities – Protect Yourself Now

00011_RT8By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

For Assisted Living Facilities (ALFs) in Florida, it’s time to do a little brushing up on your compliance material.

Beginning in January 2015, the Agency for Health Care Administration (AHCA), Office of Inspector General (OIG), Bureau of Medicaid Program Integrity (MPI), will conduct site visits to determine compliance with the Florida Medicaid Provider General Handbook and the Assistive Care Services Coverage and Limitations Handbook. This is just one of several initiatives aimed at ALFs to curtail fraud, waste, and abuse in the Florida Medicaid program.

Be Prepared.

The goal of a site visit is to determine if providers are rendering and documenting required services; to determine if assistive care services are being rendered by qualified and properly trained staff; to identify quality of care/environmental issues; and, to document and report ALF providers’ deficiencies to any managed care organizations with which the ALF is contracted.

According to the Florida Assisted Living Association (FALA), the majority of MPI sanctions concerning these fines are associated with the failure to have the following completed forms on file for each resident:

1. AHCA Form 1823 – The Health Assessment
2. AHCA Form 035 – The Certification of Medical Necessity
3. AHCA Form 036 – Medicaid Service Plan

Knowing is Half the Battle.

This announcement shows that the government will continue rigorous and thorough enforcement efforts this year. ALFs should consider this a fair warning to get supporting documentation in order. If you’re worried your ALF may not be in compliance, we suggest getting a compliance assessment. If your ALF is being audited we always suggest contacting an experienced health law attorney immediately. For general tips on how to respond to a Medicaid audit, click here for a previous blog.

Comments?

Did you know about these anti-fraud initiatives? Do you feel like your ALF is prepared for a site visit? Please leave any thoughtful comments below.

Contact Health Law Attorneys Experienced in Representing Assisted Living Facilities.

The Health Law Firm and its attorneys represent assisted living facilities (ALFs) and ALF employees in a number of different matters including incorporation, preparing contracts, defending the facility against malpractice claims, licensing and regulatory matters, administrative hearings, and routine legal advice.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

 

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright © 1999-2015 The Health Law Firm. All rights reserved.

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Hospital to Pay $3.59 Million to Settle False Claims Act Allegations Involving Ambulance Services

By Miles Indest

A hospital located in Columbia, Tennesse, has agreed to pay the federal government over $3.5 million to settle False Claims Act allegations that occurred between 2004 and 2009. The hospital submitted a voluntary self-disclosure to the U.S. Attorney’s Office and the Department of Health and Human Services (DHHS) Office of Inspector General (OIG).

Hospital Voluntarily Self-Reported After Compliance Program Revealed Billing Errors.

The hospital self-reported after its own compliance program revealed billing problems for ambulance services. The hopsital’s audit of billings reported faulty claims and payment for:

  • Ambulance services that were billed with incorrect mileage units;
  • Ambulance services that were not medically necessary or for which medical necessity was not documented;
  • Ambulance services for which a physician certification statement (PCS) was not obtained;
  • Ambulance services for which the requisite signatures were not obtained; and
  • Ambulance services that were assigned an incorrect transport level.

Hospital Works With U.S. Attorney’s Office to Resolve Billing Errors.

After notifying the U.S. Attorney’s Office that billing issues had been discovered, Maury Regional outlined a plan to determine the scope of these issues. The hospital then worked with the U.S. Attorney’s Office to bring the matter to resolution.

Ambulance Services Flagged for Medicare Audits.

In a Medicare audit of a hospital or ambulance company, ambulance services are frequently chosen for review. Ambulance services companies have increasingly become a target for Medicare audits and are often accused of billing Medicare for unnecessary services. Ambulance companies should have a compliance plan in place to assist in detecting any errors. Ambulance companies should also take all measures to prepare for a Medicare audit, before notice of an audit is received. To learn more about preparing for Medicare audits, click here.

Contact Health Law Attorneys Experienced with Medicare Audits and False Act Claims Cases.

The Health Law Firm represents ambulance companies, emergency transport services, physicians, medical practices, pharmacists, pharmacies, home health agencies, nursing facilities, hospitals, and other health provider in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving government health programs (Medicare, Medicaid, TRICARE). The Health Law Firm also represents health providers in False Claims Act cases.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources Include:

Humbles, Andy. “Maury Regional to Pay $3.5 Million to Settle False Claims Act Allegations.” Tennessean. (June 29, 2012). From: http://www.tennessean.com/article/20120629/NEWS21/306290078/Maury-Regional-pay-3-5-million-settle-False-Claims-Act-allegations

Staff. “Maury Regional Hospital to Pay $3.59 Million to Settle False Claims Act Allegations.” The Daily Herald. (June 29, 2012). From: http://www.columbiadailyherald.com/sections/news/local/maury-regional-hospital-pay-359-million-settle-false-claims-act-allegations.html

Senators Want National Investigation of State Medical Boards

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A bipartisan effort has been initiated by three U.S. Senators to launch a national evaluation of state medical boards. Senators Charles Grassley (R-Iowa), Orrin Hatch (R-Utah) and Max Baucus (D-Mont.) sent a letter to the director of the Office of the Inspector General (OIG) for the Department of Health and Human Services (HHS) requesting an investigation into state medical boards at the end of February 2012.

In the letter the senators ask the OIG to launch a national investigation of state medical boards in which the OIG would:

  • Identify challenges and process improvements for state medical boards, including those that occur across state boundaries;
  • Identify legislative changes that would better facilitate the transfer of information from federal agencies to state medical boards and between state medical boards, including as it affects those physicians needing multiple state licenses such as those practicing telemedicine;
  • Evaluate state medical board performance, including the timeliness and consistency of decision making; and
  • Determine whether the Centers for Medicare & Medicaid Services'(CMS) Quality Improvement Organizations (QIOs) and/or Part A/Part B Medicare Administrative Contractors (MACs) report adverse information, including Medicare revocations based on felony convictions, to state medical boards or the National Practitioner Data Bank (NPDB).

The OIG has not undertaken an investigation of this magnitude of state medical boards in over fifteen (15) years.

The U.S. Senate letter dated February 15, 2012 can be seen here.

If this proposed federal investigation proceeds, it is likely that more disciplinary actions will be filed against health professionals. State medical boards may feel pressure to suspend or revoke more health care licenses, which could result in a slower administrative proceeding process.

For more information about state medical boards and disciplinary actions against health providers, visit our website at www.TheHealthLawFirm.com.

Sources Include:

Christensen, Pia. “Senators Request Inquiry Into State Medical Boards.” American Association of Health Journalists. (Feb. 15, 2012). From
http://www.healthjournalism.org/blog/2012/02/senators-request-inquiry-into-state-medical-boards/

Oh, Jaime. “U.S. Senators Call for Federal Investigation Into State Boards’ Action on Physicians.” Becker’s Hospital Review. (Feb. 22, 2012). From
http://www.beckershospitalreview.com/quality/us-senators-call-for-federal-investigation-into-state-boards-action-on-physicians.html

Walker, Emily P. “Senators Want Medical Boards Investigated.” MedPage Today. (Feb. 21, 2012). From http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/31288

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Medicare Fraud Initiative Leads to Arrests of Over 100 Health Professionals

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A recent Medicare fraud operation conducted between several federal agencies has resulted in the arrest of over 100 doctors, nurses and other medical professionals. They have been charged with various crimes relating to Medicare fraud. The arrests were made on May 2, 2012 in seven cities nationwide, but more than half took place in South Florida.

This  multi-agency attack on medical professionals and health care providers was a joint effort between law enforcement agents from the Federal Bureau of Investigation (FBI), Department of Health and Human Services-Office of Inspector General (HHS-OIG), Medicaid Fraud Control Units (MFCU) and other state and local law enforcement agencies. In addition to arresting over 100 medical professionals, these agents also executed 20 search warrants in connection with ongoing Medicare fraud investigations.

Some of the charges against the health care professionals include conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of alleged Medicare fraud schemes involving medical treatments and services such as home health care, mental health services, physical and occupational therapy, durable medical equipment (DME), mental health counseling and ambulance services. These alleged Medicare fraud schemes resulted in a combined $452 million in false billings.

HHS also took other administrative action against 52 other health providers. These providers were tracked down through data analysis and are also accused of Medicare fraud. Because of the Affordable Care Act, HHS will be able to suspend payments to these providers the entire time until the investigations are completed.

Because of the severe state budget shortfalls and the federal deficit, we are seeing a tremendous increase in both Medicare and Medicaid fraud initiatives. If you are being accused of Medicare or Medicaid fraud, it is extremely important to retain an experienced health attorney immediately.

Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now Before it is Too Late

The lawyers of The Health Law Firm routinely represent physicians and other healthcare professionals in Medicare and Medicaid investigations, audits and recovery actions. They also represent physicians and health professionals in actions initiated by the Medicaid Fraud Control Units (MFCUs), in False Claims Act cases, in actions initiated by the state to exclude or terminate from the Medicaid Program or by the HHS OIG to exclude from the Medicare Program.

Call now at (407) 331-6620 or (850) 439-1001 or visit our website www.TheHealthLawFirm.com.

Sources Include:

Weaver, Jay. “Feds Arrest More Than 100 Medicare Fraud Suspects in South Florida, Nationwide.” Miami Herald. (May 02, 2012). From
http://www.miamiherald.com/2012/05/02/2779369/feds-arrest-about-100-medicare.html

U.S. Department of Justice, Office of Public Affairs. “Medicare Fraud Strike Force Charges 107 Individuals for Approximately $452 Million in False Billing.” U.S. Department of Justice. Press Release. (May 02, 2012). From http://www.justice.gov/opa/pr/2012/May/12-ag-568.html

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.