South Carolina Hospital to Pay $17 Million to Resolve False Claims Act and Stark Law Allegations

Posted on July 29, 2016 by BSW

On July 28, 2016, the U.S. Department of Justice announced, “The Lexington County Health Services District Inc. d/b/a Lexington Medical Center located in West Columbia, South Carolina, has agreed to pay $17 million to resolve allegations that it violated the Physician Self-Referral Law (the Stark Law) and the False Claims Act by maintaining improper financial arrangements with 28 physicians.”

According to the government press release, “The United States alleged that Lexington Medical Center entered into asset purchase agreements for the acquisition of physician practices or employment agreements with 28 physicians that violated the Stark Law because they took into account the volume or value of physician referrals, were not commercially reasonable or provided compensation in excess of fair market value.

Also as part of the settlement, Lexington Medical Center will enter into a Corporate Integrity Agreement (CIA) with the Department of Health and Human Services-Office of the Inspector General (HHS-OIG) that requires Lexington Medical Center to implement measures designed to avoid or promptly detect future conduct similar to that which gave rise to this settlement.

Written by: Clay J. Countryman

Enrollment Begins for Louisiana’s Medicaid Expansion

Posted on June 2, 2016 by BSW

Beginning June 1, 2016, Louisiana residents with a household income below 138 percent of the federal poverty level will be eligible to obtain healthcare coverage through the state’s Medicaid program. On January 12, 2016, Gov. John Bel Edwards signed an executive order to expand the Medicaid program, making Louisiana the 31^st state to extend Medicaid.

The U.S. Department of Health & Human Services also approved a new approach to Medicaid enrollment that will allow Louisiana to use information from the Supplemental Nutrition Assistance Program (SNAP) to determine eligibility and enroll individuals in Medicaid. Louisiana is the first state to be approved to use this enrollment strategy through the use of a state plan amendment.

Quick Facts:

Enrollment began on June 1
Coverage will be effective July 1
The State of Louisiana estimates that 375,000 new adults will enroll in coverage, with about 105,000 people already enrolled in SNAP identified as likely eligible for coverage.
Through 2016, the coverage for newly enrolled adults of up to 138% of the federal poverty line is completely funded with federal money. However, federal funding rates will decline beginning in 2017 (Federal funding rates will not fall below 90% of costs). [1]

[1] U.S. Department of Health & Human Services, HHS Secretary Sylvia M. Burwell Applauds Louisiana Medicaid Expansion Under the Affordable Care Act, (May 31, 2016).

Written by: Catherine Moore

HHS To Revise Substance Abuse Confidentiality Rules

Posted on February 10, 2016 by BSW

On Friday, February 5, the US Department of Health and Human Services announced its intention to revise the forty year old federal confidentiality standards that apply to substance use (f/k/a “substance abuse”) medical information. Originally published in 1975, these rules are found in, and often referred to simply as “42 CFR Part 2.” In announcing the revisions, HHS Secretary Sylvia M. Burwell said that the “proposal will help patients with substance use disorders fully participate and benefit from a health care delivery system that’s better, smarter and healthier, while protecting their privacy.”

The revisions will be published later this week, and we’ll be summarizing them for our clients and friends.

Written by: Greg Frost

OIG Making Widespread Review of Questionable Billing Practices for Pediatric Dental Services – Louisiana Included

Posted on February 6, 2015 by BSW

The Office of Inspector General of the United States Department of Health and Human Services is reviewing questionable billing practices related to Medicaid billing for pediatric dental services throughout Louisiana. A description of this state and national initiative can be found here. Continue reading →

OCR Bulletin: Ebola and HIPAA Privacy in Emergency Situations

Posted on November 21, 2014 by BSW

The U.S. Department of Health and Human Services, Office for Civil Rights (OCR) recently released a bulletin, HIPAA Privacy in Emergency Situations, reminding covered entities and their business associates that the protections of the HIPAA Privacy Rule are not set aside during an emergency. OCR explains that Privacy Rule is balanced to ensure that appropriate use and disclosures of protected health information (PHI) may still be made when necessary to treat a patient, protect the nation’s public health, and for other critical purposes. The bulletin further details the HIPAA Privacy Rule provisions which may allow covered entities and business associates to use or disclose PHI during an emergency.