New Form For CMS Voluntary Self-Referral Disclosure Protocol
CMS issued a new Self-Referral Disclosure Protocol (SRDP) Form that provides a streamlined and standardized format for disclosing actual or potential violations of the physician self-referral law. The SRDP Form will reduce the burden on providers and suppliers submitting disclosures to the SRDP and facilitate our review of the disclosures.
Use of the form is mandatory effective June 1, 2017. Parties submitting self-disclosures to the SRDP are encouraged, but not required, to use the SRDP Form now. Visit the SRDP webpage to learn more.
Compliagent's CEO, Nick Merkin, Guests on a Special Episode of Healthicity's Podcast Series Entitled, "An Attorney Talks Compliance."
Nick Merkin, CEO of Compliagent, chats with compliance expert CJ Wolf from his office in sunny California about compliance from an attorney’s perspective.
Merkin explained why it’s so important for organizations to see compliance from an attorney’s perspective. And how his unique point of view provides an additional layer of protection from compliance violations. In this compelling interview, Merkin explains how organizing compliance functions is, “worth its weight in gold.”
Tune in to this podcast, An Attorney Talks Compliance, to find out how to:
Focus Compliance on Processes and Infrastructure
Organize Compliance Functions to Protect Against Litigation
Mitigate Legal Liabilities That Might Arise in Healthcare
Click here to listen and
OIG and HCCA Release Jointly-Prepared "Measuring Compliance Program Effectiveness: A Resource Guide"
On March 27, 2017 the OIG and HCCA released jointly-prepared guidance as to measuring the effectiveness of your organization's compliance program. How effective is your compliance program?
Get your copy here: https://oig.hhs.gov/compliance/101/files/HCCA-OIG-Resource-Guide.pdf.
Florida Court Imposes $347 Million in Treble Damages in SNF False Claims Act Whistleblower Case
On March 1, 2017, a Florida federal court imposed more than $347M in treble (three times) damages following a jury trial in a False Claims Act case. The four defendants operated 53 skilled nursing facilities and allegedly submitted false claims to Medicare and Medicaid.
The whistleblower for the case was a former nurse at two of the facilities . The particular allegations involved submitting false claims and fraudulent records to substantiate the false claim asserting that patients needed and received more care than was necessary.
Read more here: http://blog.providertrust.com/blog/false-claims-act-court-triples-whistleblower-damages
Memorial Healthcare System Enters Into $5,500,000 Settlement with OCR for Alleged HIPAA Violations
Memorial Healthcare System reported to OCR that the PHI of 115,143 patients had been impermissibly accessed by its employees and impermissibly disclosed to affiliated physician office staff. This information consisted of the affected individuals’ names, dates of birth, and social security numbers.
Read the Resolution Agreement and Corrective Action Plan, as well as OCR's Press Release concerning the settlement here:
https://www.hhs.gov/about/news/2017/02/16/hipaa-settlement-shines-light-on-the-importance-of-audit-controls.html
New Attorney General Issues First Formal Guidance on the Evaluation of Corporate Compliance Programs in Federal Fraud Investigations
On February 8th, the U.S. Department of Justice (DOJ) issued new guidance on how the DOJ will evaluate corporate compliance programs during fraud investigations in determining whether to bring charges or negotiate settlements. The new guidance, which can be found on agency’s website as the “Evaluation of Corporate Compliance Programs,” lists 119 “sample questions” that the DOJ Fraud Section finds relevant to its analysis.
The questions are organized into the following categories:
Analysis and Remediation of Underlying Conduct
Senior and Middle Management
Autonomy and Resources
Policies and Procedures
Risk Assessment
Training and Communications
Confidential Reporting and Investigation
Incentives and Disciplinary Measures
Continuous Improvement, Periodic Testing and Review
Third Party Management
Mergers & Acquisitions
Yates Memo Invoked to Hold Owner of California Physical Therapy Provider Personally Liable For Fraud
An owner and operator of rehabilitation clinics in Walnut, Torrance, and Los Angeles, California found to have defrauded Medicare out of $3 million by billing for unnecessary services has been sentenced to 121 months in prison based on Yates Memo principles.
Read more here: http://blog.providertrust.com/blog/healthcare-business-owner-is-just-as-liable-for-fraud
Home Heath Gets New Conditions of Participation
The Centers for Medicare and Medicaid Services (CMS) released a final rule on January 13, 2017, that modernizes home health agency Conditions of Participation (CoPs).
Many home health CoPs have not been comprehensively updated since the 1990s, when most of the requirements were first created. The CoPs govern how home health agencies can qualify to participate in the federal and state healthcare system.
Katie Goodrich, CMS chief medical officer and director of the Center for Clinical Standards and Quality for CMS, stated that, “Our priority is to ensure that Medicare and Medicaid beneficiaries who receive health services at home get the highest level of patient-centered care from home health agencies. Today’s announcement is the first update in many years to Medicare and Medicaid home health agency rules and reflects current best practices for in-home care, based on recommendations from stakeholder and medical evidence.”
Currently, there are more than 5 million Medicare and Medicaid beneficiaries receiving home health services and, according to a 2016 report issued by the Office of Inspector General (OIG), Medicare reimbursed approximately $18.4 billion for home health care in 2015.
Many of the themes incorporated into the final rule relate to patient-centered care, outcome oriented processes, and data driven results. Changes addressed in the final rule include:
· An expanded patients’ rights section that explicitly sets forth the rights of home health agency patients and requires agencies to provide patients and their representatives with a notice of those rights;
· New infection prevention and control section that focuses on standard precautions as set out by national and industry best practice standards;
· An expanded patient care coordination requirement;
· A new requirement for home health agencies to implement a data-driven, agency-wide quality assessment and performance improvement (QAPI) program that will require continuous evaluation; and
· New personnel qualifications for home health agency administrators and clinical managers.
Among the above changes, the final rule incorporates additional provisions, which include: an expanded comprehensive patient assessment requirement, additional documentation requirements, and expanded supervision requirements. CMS estimates the new CoPs will cost roughly $293.3 million in the first year. With an effective date of July 13, 2017, home health agencies must be proactive in implementing the required changes to remain in compliance.
To read the full final rule please visit: https://www.federalregister.gov/documents/2017/01/13/2017-00283/medicare-and-medicaid-program-conditions-of-participation-for-home-health-agencies.
