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A Republican Senator out of Iowa, Chuck Grassley, has introduced a new bill to the Senate.  This bill, which is entitled the Strengthening Program Integrity and Accountability in Health Care Act of 2011, seeks to amend the Social Security Act in a way that prevents improper billing, either through fraud or abuse, and waste in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).  These amendments would serve to bolster and expand upon the prevention measures implemented in last year’s Patient Protection and Affordable Care Act.

This Proposed legislation, which is part of a larger trend towards eliminating fraud and abuse in the health care arean, highlights the importance of providers maintaining up to date and comprehensive compliance programs.  To discuss new and existing compliance requirements and ways to meet these requirements, please contact a Wachler & Associates attorney at 248-544-0888. 

The Department of Health and Human Service’s Office for Civil Rights will be conducting a series of workshops to help educate and train state Attorney Generals in enforcing the Health Insurance Portability and Accountability Act of 2009 (HIPAA).  These workshops will include reviews of HIPAA and state privacy laws and the new enforcement role of the Attorney Generals as promulgated under the Health Information Technology for Economic and Clinical Health Act (HITECH).

These workshops are part of a larger plan to increase awareness about HIPAA compliance and enforcement.  Experts anticipate an increase in HIPAA related enforcement activity in the coming months.  To discuss possible improvements to your current compliance program, or to develop a new program, contact a Wachler & Associates Attorney at 248-544-0888.

The Government Accountability Office released a report on March 2, 2011, which concludes that inefficiencies and duplication in Government Programs are costing taxpayers billions every year.  This report, entitled “Opportunities to Reduce Potential Duplication in Government Programs, Save Tax Dollars and Enhance Revenue,” was issued to aid lawmakers in setting the federal budget.  The report claims that 10% of all Medicare payments are either fraudulent or otherwise improper and that these payments cost the federal government roughly $48 billion.  The report goes on further to specifically call on CMS and HHS to reign in these, and other health care related costs.  Reports such as this will undoubtedly increase audit activity from CMS contractors in an already aggressive audit environment.  If you are the subject of an audit from a RAC, ZPIC, MAC or other Medicare or CMS contractor, please contact a Wachler & Associates attorney.

The Justice Department is seeking clarification on a ruling made by U.S. District Court Judge Roger Vinson.  Judge Vinson, in his ruling on the implementation of the Patient Protection and Affordable Care Act, suggested that the government was enjoined from implementation of the Act.  The DOJ now wants the Judge to clarify whether or not there is an injunction on the implementation of the Act.  This injunction would only be applicable to the 26 states that were a party to the suit.

The ruling on this case could have a significant impact on individuals and providers in the affected states and should be carefully watched.  For information on health care reform and compliance with the various provisions, please contact a Wachler & Associates attorney. 

According to a Department of Health and Human Services news release issued on Thursday, February 17, 2010, the Medicare Strike Force has indicted 111 health care providers for allegedly billing false claims to Medicare.  HHS called this the “largest ever federal health care fraud takedown.”

21 defendants were arrested in Detroit for allegations of billing false claims including home health care, nerve conduction tests, psychotherapy, physical therapy and podiatry.  Arrests were also made in Florida, New York, Texas, California, Louisiana and Illinois.

HHS also announced that it is expanding Strike Force operations to two additional cities – Chicago and Dallas.  Cities already under scrutiny of the Strike Force include Detroit, Miami, Houston, Brooklyn, Tampa and Baton Rouge.

Physicians should take note of the fact that Medicare’s electronic prescribing program, while offering incentives now, will soon be changed to a penalty system for those who do not adopt e-prescribing.  Early adopters are currently being rewarded with a percentage of their total Medicare payments refunded to them.  In 2011 and 2012 the amount of the refund is 1% and it drops to .5% in 2013.  Penalties for those who do not adopt e-prescribing will begin in 2012 and will be 1% of Part B earnings in 2012 for those eligible physicians who do not meet e-prescribing criteria in at least 10 Medicare office visits from January 1, 2011 to June 30, 2011.

Physicians should also be aware of the fact that incentives will not be available from both the Medicare e-prescribing and Medicare EHR incentive programs simultaneously, i.e. those physicians receiving EHR incentives will not also be eligible for e-prescribing incentives, since e-prescribing is part of the “meaningful use” criteria.

If you have questions regarding applying for and qualifying for the e-prescribing programs or meeting the meaningful use criteria for the EHR incentive programs, please contact a Wachler & Associates attorney at 248-544-0888 or www.Wachler.com. 

CVS recently settled a suit with the US Attorney’s office for allegedly having a disqualified pharmacist fill prescriptions in their New York and New Jersey stores.  The settlement was for just under one million dollars.  The pharmacist had been excluded from participating in federal programs and CVS failed to pick up on this fact through its current system of background checking prospective employees.

This situation highlights the importance of thorough background checks for all healthcare employees.  These background checks should specifically check the status of the employee with respect to exclusion from any federal programs.  It can be a costly mistake to have an excluded employee bill for otherwise reimbursable services.

Whether you want to review your current compliance protocol, or construct an entirely new compliance program, one of our attorneys can help you navigate the labyrinth of complex healthcare compliance regulations.  Contact a Wachler & Associates attorney at 248-544-0888 or at www.Wachler.com.  

On January 13, the Department of Health and Human Services’ Office of Inspector General (OIG) issued a special fraud alert to remind durable medical equipment (DME) suppliers that unsolicited telephone calls to Medicare beneficiaries are prohibited by federal law. The fraud alert referred specifically to instances in which independent marketing firms make unsolicited contact with Medicare beneficiaries to market the DME supplier.

The Social Security Act prohibits such unsolicited contact by a DME supplier, except in three specific situations:

(1) when the beneficiary has given express written permission to the supplier to contact him or her by phone;