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Delaware Health Law Blog

Written by Joanne Ceballos on January 8, 2015

CMS Issues Proposed Revisions to Medicare Regulations and State Survey Agency Guidance with Respect to Same-Sex Spouses

On December 12ththe Centers for Medicare and Medicaid Services issued a proposed rule to revise Medicare regulations to afford same-sex spouses equal rights in Medicare and Medicaid participating facilities.  The proposed changes to Medicare conditions of participation (CoPs) for providers, conditions for coverage (CfCs) for suppliers, and requirements for long-term care facilities, follow the U.S. […]

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Written by Melony Anderson on December 10, 2014

New Rule Expands Bases on Which Providers Can Be Excluded from Participation in Medicare

On December 3, the Centers for Medicare & Medicaid Services (“CMS”) issued a new rule that enhances CMS’s ability to exclude or remove providers from participation in Medicare. According to a press release issued by CMS, the new rule is designed to “prevent physicians and other providers with unpaid debt from re-entering Medicare, remove providers with patterns or practices of abusive billing, and implement other provisions to help save more than $327 million annually.”

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Written by Joanne Ceballos on December 3, 2014

Physical Therapists’ Board Proposes Telehealth and Dry Needling Regulations

In August of this year Governor Markell signed a bill overhauling Chapter 26 of Title 24 relating to the practice of physical therapy and athletic training. Among other things, the legislation expanded the scope of practice to include telehealth and dry needling. Further to the legislation, the Examining Board of Physical Therapists and Athletic Trainers has proposed regulations regarding standards and requirements for the practice of telehealth by physical therapists, athletic trainers, and physical therapist assistants, as well as prerequisites for the performance of dry needling by physical therapists.

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Written by Nate Trexler on November 25, 2014

New Requirements for Delaware Free Standing Surgical Centers

On November 1, the Delaware Department of Health and Social Services (“DHSS”) promulgated new regulations governing the licensure and operation of free standing surgical centers (“FSSCs”), more commonly referred to as ambulatory surgery centers. The comprehensive regulatory changes became effective November 11 and raise a number of new issues for owners and potential investors of FSSCs.

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Written by Nate Trexler on November 10, 2014

HHS Office of Inspector General Fraud and Abuse Focus: FY 2015 Work Plan

Each year, the Office of Inspector General (“OIG”) at the Department of Health and Human Services announces the agency’s new and continuing initiatives to combat health care fraud and abuse. The annual OIG Work Plan helps health care providers understand new, and some recurring, areas that the OIG believes are key in the fight to protect the federal fisc. We have previously discussed such key initiatives to help Delaware providers identify and focus on potential areas of compliance risk before issues arise.

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Written by Joanne Ceballos on October 28, 2014

With CMPs for Employing Excluded Individuals on the Rise, Providers Should Review Their Exclusion Check Policies

Over the past three months the Office of Inspector General of the U.S. Department of Health and Human Services (“OIG”) has imposed civil monetary penalties (“CMP”) on 13 health care providers who employed individuals excluded from participating in Medicare and Medicaid. Most of these CMPs (10) were imposed on health care providers who self-reported the issue to the OIG, which likely explains the rise in these types of matters. The CMPs ranged from $10,000 imposed against a surgery center to $1.9 million levied against a diagnostic laboratory and imaging company.

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Written by Joanne Ceballos on September 30, 2014

HIPAA Compliance: Two Things to do Going Forward

Since the publication over 20 months ago of the HIPAA Final Omnibus Rule, there has been no shortage of recommendations and advice to health care providers from trade organizations, industry consultants, attorneys and the Office of Civil Rights of the U.S. Department of Health & Human Services (“OCR”) about the steps providers should take in order to achieve HIPAA compliance. Last week marked a final deadline for Omnibus Rule compliance—September 23, 2014, was the date by which covered entities were required to update their agreements with business associates to include certain provisions required under the Rule.

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Written by Melony Anderson on September 24, 2014

Physician Supervision Requirements under CMS Regulations – False Claims Act Cases on the Rise

In 2013, the Department of Justice collected over $3.8 billion in qui tam and non-qui tam settlements and judgments under the False Claims Act (“FCA”). Of the total amount collected, $2.7 billion, or 70% were in cases in which the Department of Health and Human Services (“HHS”) was the primary client agency. In comparison, cases from the Department of Defense represented just 1% of the total collections. Surprisingly, the total numbers for 2013 were actually slightly lower than 2012 numbers. In 2012, total collections were $4.9 billion, with HHS cases representing $3.1 billion, or 63%.

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Written by Nate Trexler on September 16, 2014

The Medicare Appeal Conundrum

We have previously discussed in a number of forums the success achieved by providers in appealing Medicare claim audits and denials to the Administrative Law Judge (“ALJ”) level of the statutory appeal process. Because of the success in overturning claim decisions, more and more providers have exercised their rights to appeal claim determinations or audits resulting in alleged overpayments. The number of appeal requests submitted to the Office of Medicare Hearings and Appeals (“OMHA”) increased from approximately 1,250 per week in 2012 to 15,000 per week in 2014. This incredible increase has caused a log jam, where the average processing time for an appeal request is now 464 days and providers are awaiting ALJ hearings in over 1 million appeals.

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Written by Nate Trexler on September 9, 2014

Delaware Facilities that Perform Invasive Medical Procedures: Prepare for Enforcement

Back in February, the Delaware Department of Health and Social Services published a final rule setting forth standards for never before regulated Delaware health care facilities: medical and dental offices.

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