Wednesday, June 21, 2017

Rose Willis (Member, Troy & Saginaw) Authors Article on Certificates of Need for Healthcare Michigan

Attorney Rose Willis (Member, Troy & Saginaw) wrote an article titled “Frequently Asked Questions on the Certificate of Need Process for Surgical Services,” which was published in the recent edition of Healthcare Michigan.

The article focuses on how entities in Michigan can obtain a Certificate of Need, a process that can be time consuming and challenging.

“The CON process is information driven and can be challenging for the parties involved,” writes Ms. Willis. “However if the parties are properly prepared and have a good understanding of the requirements to win a CON, it should not unnecessarily delay the overall project nor should it place the parties at risk of unnecessary legal liability or cost.”

To read the complete article, please click here.

Friday, June 16, 2017

Recent Case Serves as Reminder to Take Care in Structuring Sales of Physician Practices

By: Ralph Levy, Jr.

Physicians Should Carefully Review Documents to Verify Information Accurately Reflects the Desired Structure of the Sale.

Over the past few years, hospitals, health systems, and practice management companies have increased their efforts to acquire physician practices. Moreover, physician groups are increasingly interested in selling their practices to these interested purchasers. The primary reasons for this trend are varied but in general are prompted by an increased focus the delivery medicine a seamless integrated system by health providers.  

For physicians or other health care providers that are considering practice sales, care should be taken in structuring the sale to minimize the federal taxes payable as a result of the sale.  In general, there are two choices to structure the practice sale:

1)  Stock sale: Under this sale structure, which works only if the practice is incorporated, the physicians sell stock in their professional corporation or professional association to the interested purchaser.

2)  Asset sale: Under this sale method, the practice itself sells its tangible and intangible assets to the purchaser. In addition to these two choices, the sale can be structured as a hybrid using a combination of these sales methods. A final and much less common option would be for a portion of the sale consideration to be paid by the purchaser to one or more selling physicians and characterized as a sale of personal goodwill.

 
Please read the entire article here.
 
Ralph Levy, Jr. is Of Counsel in the Nashville TN office. He may be reached at 615-620-1733.

Tuesday, June 6, 2017

PREVENTING OVERPAYMENTS FROM BECOMING FALSE CLAIMS

By:  Andrew Sparks


Overpayments to healthcare providers receiving Medicare reimbursements are at risk of civil and criminal enforcement action if not attuned to a particular reimbursement rule and diligent in compliance with the rule’s requirements. In short, the overpayment rule turns potential billing mistakes into fraud. A healthcare provider cannot keep money paid in error. The Government and relator bar are certain to address fully this theory of liability against every healthcare provider who ends up in litigation. If an overpayment is identified and the provider does nothing, then the provider will end up paying significantly more to the Government. It’s the proverbial pay (less for compliance) now or more (to the Government) later. Put differently, healthcare providers should address the smaller problem sooner rather than the bigger problem later.  Last year Centers for Medicare and Medicaid Services (CMS) released its Final Rule concerning overpayment procedures for Medicare Parts A and B. The Rule implements Section 6402(a) of the Affordable Care Act, which addresses the identification, reporting and repayment of overpayments. Healthcare providers reasonably should expect to see increased use of this provision in Government enforcement and whistleblower lawsuits now that the overpayment requirements have been disseminated fully throughout the healthcare community. 

Last year Centers for Medicare and Medicaid Services (CMS) released its Final Rule concerning overpayment procedures  for Medicare Parts A and B. The Rule implements Section 6402(a) of the Affordable Care Act, which addresses the identification, reporting and repayment of overpayments. Healthcare providers reasonably should expect to see increased use of this provision in Government enforcement and whistleblower lawsuits now that the overpayment requirements have been disseminated fully throughout the healthcare community.

Please read the entire article here.
 

Andrew L. Sparks is a Of Counsel in Dickinson Wright’s Lexington office. He can be reached at  859.899.8734.



 

Thursday, June 1, 2017

Health System Paid $2.4 Million Settlement After Identification in a Press Release of a Patient Who Was Engaged in Fraud

By: Kimberly Ruppel

The U.S. Department of Health and Human Services Office for Civil Rights (“OCR”) announced a $2,400,000 settlement with Memorial Hermann Health System (“MHHS”) to resolve an investigation of an unauthorized disclosure of protected health information (“PHI”) as a potential violation of the Privacy Rule of the Health Insurance Portability and Accountability Act (“HIPAA”).  In addition to payment of the settlement, MHHS agreed to enter into a Corrective Action Plan with provisions for training and documenting compliance efforts.  

MHHS is the largest not-for-profit health system in southeast Texas, consisting of 13 hospitals, 8 cancer centers, 3 heart and vascular institutes and 27 sports medicine and rehabilitation centers, and employs approximately 24,000 people.  

In September 2015, a patient at one of MHHS’s clinics presented an allegedly fraudulent identification card to office staff.  The staff person alerted appropriate authorities and the patient was arrested.  So far, there was no violation of HIPAA because the staff person was disclosing PHI in furtherance of permissible law enforcement efforts.

Where things began to go awry for MHHS was the initial publication of a press release identifying the patient by name in the title of the release, which was issued to fifteen media outlets and/or reporters.  MHHS further compounded its error by disclosing the patient’s name during three meetings with an advocacy group, state representatives, and a state senator.  To make matters worse, MHHS then disclosed the patient’s name in a statement on MHHS’s website.  

None of these disclosures were authorized by the patient, and MHHS senior leadership was involved.  Further, MHHS failed to document any sanctions imposed against its violators.  These factors may explain why the OCR required a particularly high settlement amount.   

Lessons learned:  (1) disclosure of PHI for law enforcement purposes does not include identification of the alleged criminal to other parties; (2) HIPAA training is important for all employees, not just medical providers and treaters and administration who deal more directly with patients; (3) sanctions against offending employees must be promptly implemented and documented.
 
 
 
Kimberly Ruppel (Member, Troy) is a commercial litigator with experience in class actions, electronic discovery, ERISA, probate and healthcare disputes. Please contact Kimberly at 248-433-7291.