Most hospitals are intimately familiar with the application of the Emergency Medical Treatment and Labor Act (EMTALA) in medical cases. It becomes more complex and challenging when an individual presents to a hospital’s emergency department (ED) with symptoms of a psychiatric disturbance. We are seeing increased focus on these types of cases by healthcare regulators. Multiple recent enforcement actions include two settlements – $360,000 and $1.3 million – that are far afield from the “usual” $50,000 penalty (or $25,000 for smaller hospitals). From these settlements, we see how problematic practices can significantly compound penalties, particularly in psychiatric emergency cases. Continue reading
Category Archives: Health Information
Additional Challenges for Off-Campus Provider-Based Hospital Departments
Proposed Reduction of Payment Rates for Non-excepted Off-campus Provider-Based Hospital Departments Paid Under the Medicare Physician Fee Schedule
Medical facilities owned by hospitals but located off-campus are facing new challenges on both the state and federal levels. CMS recently proposed a rule updating certain payment policies and rates for the Medicare Physician Fee Schedule (Proposed Rule). Among other provisions, the Proposed Rule slashes payment rates for non-excepted off-campus provider-based hospital departments that are now paid according to the Medicare Physician Fee Schedule. The Proposed Rule will be published in the Federal Register on July 21, 2017; the comment period will close on Sept. 11, 2017. Continue reading
Conducting Required Reviews Can Save Your Facility from Embarrassment – and Worse!
Even though we know the old saying “an ounce of prevention is worth a pound of cure,” background checks on on personnel can sometimes fall through the cracks. Here are a few examples of times that make us wish we would have double-checked to be sure they were getting done:
- A state surveyor is on-site investigating and advises that the allegation of neglect or abuse is against a tech who was convicted for beating up his father a year before he was hired.
- In employing a favorite PRN nurse who has been around for a couple of years, you learn that she never obtained a license when she moved here from Texas. You realize there may now be returnable overpayments, because she is not appropriately licensed to perform the services in our state.
- You want to impress your new venture partner, and cringe when they discover in due diligence that your team has not checked the excluded provider or debarred contractor lists in a few years.
Florida Supreme Court Decision Raises Concerns About the Constitutionality of Statutory Caps on Damages in Medical Malpractice Cases
The Supreme Court of Florida recently found Florida’s statutory caps on medical malpractice damages for pain and suffering (noneconomic damages) to be unconstitutional as violating the equal protection clause of the state’s constitution. This ruling is concerning for healthcare providers because, not only could it result in additional liability in malpractice cases, but it could also cause an increase in malpractice insurance premiums. Continue reading
eClinicalWorks Case Raises New Questions
On May 31, 2017, the U. S. Department of Justice (DOJ) announced that eClinicalWorks (ECW) agreed to pay a $155 million settlement and enter a corporate integrity agreement with the OIG to resolve allegations that ECW caused its health care provider customers to submit false Medicare and Medicaid claims for meaningful use payments in violation of the False Claims Act (FCA). Under the corporate integrity agreement, ECW agreed to strict compliance and reporting obligations and to provide the latest version of ECW’s EHR software to each of ECW’s current customers free of charge. Continue reading
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