Health Law Blog - Healthcare Legal Issues

Archive for the ‘Hospice Legal Issues’ Category

OIG Posts 2013 Annual Work Plan

Wednesday, October 3rd, 2012

2013 Work Plan Published By The Office of Inspector General 

Yesterday (October 2, 2012), the  HHS Office of Inspector General (OIG) published its Work Plan for Fiscal Year 2013.  The work Plan is published annually by the OIG and contains brief descriptions of activities that OIG plans to initiate or continue for fiscal year 2013.  The Work Plan has become a source for health care providers to identify potential risk areas within their organization so that thay can tailor their compliance efforts to address the issues that the OIG believes are important.

We are in the process of reviewing the OIG 2013 Work Plan and will post a summary or a series of articles over the upcoming days.

Anti-kickback Statutes Safe Harbor Regulations

Thursday, December 8th, 2011

Anti-kickback Statutes and Safe Harbor Regulations

Medicare Antikickback Statute Safe HarborsOverview: On the books since 1972, the federal anti-kickback law’s main purpose is to protect patients and the federal health care programs from fraud and abuse by curtailing the corrupting influence of money on health care decisions. Straightforward but broad, the law states that anyone who knowingly and willfully receives or pays anything of value to influence the referral of federal health care program business, including Medicare and Medicaid, can be held accountable for a felony. Violations of the law are punishable by up to five years in prison, criminal fines up to $25,000, administrative civil money penalties up to $50,000, and exclusion from participation in federal health care programs.

Because the law is broad on its face, concerns arose among health care providers that some relatively innocuous — and in some cases even beneficial — commercial arrangements are prohibited by the anti-kickback law. Responding to these concerns, Congress in 1987 authorized the Department to issue regulations designating specific “safe harbors” for various payment and business practices that, while potentially prohibited by the law, would not be prosecuted.

Home Health Hospice Face-to-Face Certification Rule

Thursday, April 7th, 2011

CMS Begins Enforcing Home Health and Hospice Face To Face Rule

On March 31, 2011, the Center for Medicare and Medicaid Services issued a statement that it intends to begin enforcing the home health and hospice “face-to-face” requirement.  The Accountable care Act established a face-to-face encounter requirement before eligibility for Medicare home health services can be certified.  A certifying physician is now required to document that the physician or a non-physician practitioner that works with the physician has seen the physician “face-to-face.”  Face-to-face encounters with hospice patients must also occur  prior to the patient’s 180th-day re-certification, and each subsequent re-certification.

 The face-to-face requirement went into effect on January 1,  2011 but CMS announced in December 2010 that it would suspend enforcement for the first calendar quarter of 2011 in order to give providers additional time to establish compliance protocols.  CMS has stated that it expects providers (home health and hospices) to have fully established and implemented internal processes to be in compliance with the face-to-face requirement and by April 1, 2011, Home health providers and physicians are required to ensure that a face-to-face encounter with a home health or hospice patient occurs within the 90 days prior to the start of care, or within the 30 days after the start of care in order to appropriately certify the need for home health services.  Documentation of the face-to-face requirement must be included with patient certifications.

John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
500 First Street, Suite 8000
P.O. Box 8050
Wausau, WI 54402-8050

Tel 715.845.4336
Fax 715.845.2718

Ruder Ware is a member of Meritas Law Firms Worldwide

Search
Disclaimer
The Health Care Law Blog is made available by Ruder Ware for educational purposes and to provide a general understanding of some of the legal issues relating to the health care industry. This site does not provide specific legal advice and you should not use the information contained on this site to address your specific situation without consulting with legal counsel that is well versed in health care law and regulation. By using the Health Care Law Blog site you understand that there is no attorney client relationship between you and Ruder Ware or any individual attorney. Postings on this site do not represent the views of our clients. This site links to other information resources on the Internet; these sites are not endorsed or supported by Ruder Ware, and Ruder Ware does not vouch for the accuracy or reliability of any information provided therein. For further information regarding the articles on this blog, contact Ruder Ware through our primary website.