Health Care Law Blog

HIPAA Changes Taking Effect; Are You Ready?

With the HIPAA changes taking effect in September of 2013, many health care providers are scrambling to update notices and policies to become compliant. One such notice that needs to be updated is the Notice of Privacy Practices. Read More ›

Categories: HIPAA

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Omnicare Settles Whistleblower Lawsuit Alleging Kickback Scheme With Nursing Homes

Omnicare Inc., the nation's largest dispenser of prescription drugs in nursing homes, announced on October 23, 2013, that it has agreed to pay $120 million to settle a whistleblower lawsuit alleging kickbacks to nursing homes.

The whistleblower in the case, an Ohio pharmacist named Donald Gale, worked for Omnicare from 1993 until 2010. The lawsuit, filed in federal court in Cleveland in 2010, accused Omnicare of giving discounts for prescription drugs to nursing homes for certain Medicare patients in return for referrals of other patients at higher prices paid for by the federal government. Read More ›

Categories: Billing/Payment, Fraud & Abuse, Medicare/Medicaid, Pharmacy, Providers

Posted by: Jennifer B. Van Regenmorter

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The Michigan Health Insurance Marketplace: How did the Rollout Go?

Technical glitches. Partisan rancor. Breathless media coverage. The rollout of the online Health Insurance Marketplaces (also known as Exchanges) did not lack for drama or controversy. The unveiling of the Marketplaces, one of the key elements of the Patient Protection and Affordable Care Act, was perhaps the most anticipated and controversial website launch in history. The website www.healthcare.gov was flooded with traffic from the moment it opened on October 1, 2013 and many interested consumers ran into trouble. While most of the extensive media coverage of the Marketplaces focused on problems nationally, we wanted to take a look at how Michigan’s Marketplace (and consumers) fared. Read More ›

Categories: Health Care Reform, Health Insurance Exchange

Posted by: Mindi M. Johnson

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FDA Issues Final Guidance on Mobile Medical Apps

On September 23, 2013, the U.S. Food and Drug Administration (FDA) issued final guidance governing the development of mobile medical apps. The FDA will focus its oversight on apps that it deems potentially harmful to consumers if they do not function properly. This, therefore, largely excludes the majority of medically-oriented mobile apps currently on the market as they pose minimal risk to consumers. Read More ›

Categories: Regulatory

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Notice of Insurance Marketplace - Due Date Approaching

An October 1, 2013 deadline is looming for many employers to give employees written notices under the Patient Protection and Affordable Care Act (PPACA, commonly known as the health care reform act.) Read More ›

Categories: Health Care Reform

Posted by: Mindi M. Johnson, Johanna M. Novak

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Michigan Senate Approves Medicaid Expansion

The Michigan Medicaid expansion saga has seemingly come to an end, as the Republican-led state Senate narrowly approved Medicaid expansion on Tuesday, August 27 in a 20-18 vote. Eight Republicans joined 12 Democrats to pass a bill that will bring billions of dollars in federal dollars to Michigan to implement a major element of the Patient Protection and Affordable Care Act. Under this bill, approximately 400,000 additional Michigan residents will be eligible for Medicaid coverage.

The vote came after lengthy debate in the Senate on the measure, and passed after "eleventh hour" legislative maneuvering. The Michigan House, which previously passed a Medicaid expansion bill, will likely approve the Senate version of the bill next week. If passed, it will be sent to Governor Snyder's desk for his signature.

Categories: Health Care Reform, Medicare/Medicaid, Providers

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Michigan Senate Panel Moves Three Alternative Medicaid Bills Out of Committee

In early July, we updated our readers regarding the status of the Medicaid expansion debate in Michigan. At that time, a House-passed bill - supported by Governor Snyder - languished in a Senate committee because it was blocked by Senate Republicans who opposed the measure. Get an update ›

Categories: Health Care Reform, Medicare/Medicaid, Regulatory

Posted by: Johanna M. Novak

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NPDB Guide for Reporting Clinical Privileges Actions

The National Practitioner Data Bank (NPDB) has published a quick guide to assist hospitals and health care entities in reporting actions that adversely affect clinical privileges held by physicians, dentists and other health professionals.

The guide (We have identified that the following link is no longer active, and it has been removed) lists several “reporting scenarios” and indicates the type of report that may be required (initial adverse action report, revision-to-action report, correction report, or no report). The guide also summarizes the reasons for voiding a previous report (report was erroneously submitted, action was not reportable, or action was reversed or overturned).

The guide is a helpful starting point for a hospital or health care entity that is involved in a privileging action. However, the scope and timing of reporting requirements under the NPDB regulations can be quite complex. Considering the very serious implications from reporting—or not reporting—an adverse privileging action, it would be prudent to only use the guide as a quick reference and not as a decision-making tool.

If you have any questions about the guide, please contact Richard Kraus at 517.371.8104 or by using the email form below.

Categories: Hospitals, Physicians

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Health Care Providers Face Steep Penalties for Medicare/Medicaid Fraud

So far, July has been a busy month for health care fraud enforcement across the country.

On July 18, Divyesh Patel, owner of Alpine Nursing Care Inc. in North Randall, Ohio, was sentenced to two years in prison after pleading guilty to one count of conspiracy to commit health care fraud and four counts of health care fraud. Patel was also ordered to pay total restitution of $1,939,864 to the Medicaid Program in Ohio. According to court documents, Patel hired Belita Mable Bush as the office manager despite knowing that Bush had been convicted of a health care-related felony and excluded from involvement in billing federal health care programs. From June 1, 2006 to October 18, 2009, Patel conspired with Bush to defraud Medicaid by billing for services that had never been performed or that had been performed by excluded individuals. The conspiracy resulted in losses of approximately $1.9 million to the Medicare and Medicaid programs. Bush was convicted on similar charges and will be sentenced next month. Read about more cases ›

Categories: Fraud & Abuse, Health Care Reform, Hospitals, Medicare/Medicaid, Physicians

Posted by: Julie LaVille Hamlet

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Pioneer ACOs Find Blazing New Trails Isn't Always Easy

According to a recent Modern Healthcare article, up to 9 of the 32 Pioneer Accountable Care Organizations ("ACOs") may be leaving the program. Four have already notified providers of such withdrawal. Of the 9, 4 of the departing ACOs tentatively say they will be joining Medicare's lower- risk ACO alternative – the Medicare shared savings program. The deadline for deciding whether or not to remain in the Pioneer program is July 31, 2013. Read More ›

Categories: Accountable Care Organizations, Health Care Reform, Hospitals, Medicare/Medicaid, Physicians

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