New Law Affecting Texas Long-Term Care Providers and the IDR ProcessTexas legislators signed a new law, which will be effective June 10, 2019. Key provisions of the law that affect Texas long-term care providers include:
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Post Acute Medical Agrees to Pay More Than $13 Million to Settle Allegations of Kickbacks and Improper Physician RelationshipsPost Acute Medical, LLC (“PAM”) agreed to pay the U.S., Texas, and Louisiana a total of $13,168,000 for purported violations of false claim statutes, which resulted in Anti‑Kickback Statute and Stark law violations. The settlement resolves allegations initiated by a whistleblower lawsuit. The DOJ alleged that PAM entered into contracts with physicians to induce referrals to PAM’s facilities. PAM also allegedly entered into “reciprocal referral relationships” with unaffiliated healthcare providers, including home health companies.
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Puerto Rican Physician Indicted with 18 Counts of Health Care FraudJuly 19, 2018, Dr. Miguel Rivera-Sanabria was charged with 18 counts of health care fraud, 3 counts of aggravated identity theft, 3 counts of false statements, and 8 counts for attempted distribution of controlled substances. Dr. Rivera-Sanabria allegedly submitted false claims for services that were never performed, causing Medicare to pay $225,250. He faces up to ten years of imprisonment for the health care fraud charges, and two years for the aggravated identity theft charges.
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Medicare Improperly Paid Providers For Nonemergency Ambulance Transports To Destinations Not Covered By MedicareOIG found Medicare improperly paid $8.7 million for nonemergency ambulance transports. Medicare only covers ambulance transports to certain destinations, such as to skilled nursing facilities (SNFs), and
from a SNF to the nearest supplier of medically necessary services. OIG recommends CMS directs contractors to (1) recover payments and identify recent improper payments; (2) send providers notice of improper payments made outside of the Medicare recovery periods; and (3) require contractors to implement prepayment edits. |
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Are you compliant with CMS' texting policy?December 28, 2017, CMS published policy memorandum, S&C 18-10- ALL and provided renewed guidance on texting to clarify health care providers' oblication to protect patients' protected health information ("PHI"). The memorandum makes it clear that texting is a common and valuable communication tool for providers as well as the entire health care team; however, texting is only permissible when providers and other members of the health care team utilize secure and encrypted systems/platforms in order to comply with Health Insurance Portability and Accountability Act (“HIPAA”) and the Medicare conditions of participation (“CoPs”). Nonetheless, texting orders is not permissible and is not compliant with the
CoPs. Orders must only be transmitted as a hand-written order or a computerized provider order entry. Because this may be evaluated and investigated by a surveyor coming to your facility, it is important to maintain a robust and updated policy regarding texting among physicians and other members of the health care team. |
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Will nursing facilities get reprieve in 2018?Civil monetary penalties have been painful in 2017 for long-term care providers throughout Texas. On October 27, 2017, CMS published policy memorandum S&C: 18-01- NH that could bring a wave of change to the long-term care industry and some relief for nursing facility owners, in particular for the smaller, family-owned facilities across Texas. This memorandum affects Skilled Nursing Facilities, Nursing Facilities and dually participating facilities, which are always required to be in substantial compliance with Medicare and Medicaid requirements. One critical change concerns immediate jeopardy violations. According to the memorandum, it will no longer be CMS’ policy to impose a civil monetary policy for the entire duration that immediate jeopardy was cited if there is serious injury, harm, impairment or death. This means instead of a per day penalty, a facility could only be cited a per instance penalty. CMS penalties can add up and affect the reputation and operation of your facility.
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