Following her conviction on one count of conspiracy to submit false and fraudulent claims to Medicare through her employer — American Therapeutic Corporation (ATC) and a related company, American Sleep Institute — Nichole Eckert a mental health therapist has been sentenced to four years in prison, followed by three years of supervised release. She also was ordered to pay more than $72 million in restitution, jointly and severally, with her co-defendants for participating in a $205 million Medicare fraud scheme.
ATC, headquartered in Miami, operated partial hospitalization programs (PHPs) in locations in South Florida and Orlando. According to the U.S. Attorney’s press release, ATC secured patients by paying kickbacks to assisted living facility owners and halfway house owners who would then steer patients to ATC for PHP treatments.
The referred patients were found to be ineligible for the PHP treatments which ATC billed to Medicare. Funds received from Medicare were laundered by some of the co-conspirators to create cash to pay kickbacks.
Eckert’s role was to fabricate patient files to substantiate Medicare claims and make it appear that ATC patients were qualified for PHP treatment. The false records also showed that patients were receiving the intensive, individualized treatment PHPs are supposed to provide. Some or the patients were ineligible for PHP treatments. ATC, a related company, Medlink, and dozens of individuals have previously been convicted at trial or pleaded guilty for their participation in the scheme.
The Office for Civil Rights (OCR) — the folks who brought us the Health Insurance Portability and Accountability Act of 1996 (HIPAA) –has released new and far-reaching changes to the HIPAA privacy, security and enforcement rules.
The new rule will be published in the Jan. 25 Federal Register and will implement statutory requirements that were enacted in the HITECH Act as part of the American Recovery and Reinvestment Act of 2009.
Among other things, the rule clarifies when breaches of unsecured health information must be reported to HHS. It eliminates the prior breach notification rule’s “harm standard” and replaces it with “a more objective standard.”
Although the new rule is effective March 26, 2013, covered entities and business associates have until Sept. 23, 2013 to comply with its provisions.
Jan. – Feb. 2013 – Now that the U.S. Supreme Court has upheld the Affordable Care Act, ambulatory surgery center operators and other healthcare providers are preparing for a new future with increased collaboration.
In an article published in Florida Medical Business, Florida Health Law Center co-founder Jodi Laurence says it’s all about trying to provide quality care at an efficient cost and being able to track outcomes.
Click here to read the full story.
Jan. 14, 2013 – On Jan. 10, President Obama signed into law the Strengthening Medicare and Repaying Taxpayers (SMART) Act passed by Congress in December.
The SMART Act is aimed at simplifying compliance with the Medicare Secondary Payer (MSP) Act. MSP has been around since the 1980s and made Medicare the secondary payer to personal injury insurance, health insurance, and workers’ compensation plans.
MSP required parties who have settled a liability case, such as a workers’ compensation or auto accident case settlement or judgment, to determine and repay the Medicare program for any conditional payments it made on behalf of a beneficiary in connection with the liability case. This has sometimes been difficult because getting the necessary information out of Medicare is challenging, making it hard to determine how much Medicare should be paid.
The SMART Act addressed this problem by requiring CMS to establish a website whereby individuals or insurance companies can access information on claims paid by Medicare. It also requires that Medicare provide conditional payment information within 65 days of a request. Medicare is also required to respond to individual disputes regarding Medicare’s conditional payments within 11 days and to establish regulations providing appellate rights regarding his determinations of conditional payments made.
The SMART Act also establishes a three-year statute of limitations on MSP actions by Medicare to recover claims.
Jan 5, 2013 – The American Taxpayer Relief Act of 2012–passed by Congress on January 1, 2013, and signed by President Obama the next day to extend several tax cuts and help avert the so-called “fiscal cliff”–postponed the sustainable growth rate cuts to physicians, but “roughly $15 billion of the cost of this measure will be funded by hospitals in the form of reduced payments over the next decade.”
Congress may revisit those cuts, because hospitals are “up in arms,” said attorney Jodi B. Laurence, a founding partner of the Florida Health Law Center in Davie.
Click here to read the full story.
Dec. 31, 2012 – Effective Jan. 1, 2013, one of the changes made as a result of the enactment of the new PIP law is the requirement that entities which previously were exempt from healthcare clinic licensure are now required to become licensed.
This change likely was directed specifically at those healthcare practices that are jointly owned by physicians and chiropractors. Although such entities are excluded from licensure under §400.9905(g), they are now required to be licensed as healthcare clinics if they intend to bill for and receive reimbursement for healthcare services under PIP insurance policies.
Those entities that are jointly owned by physicians and chiropractors and which are not currently licensed as healthcare clinics should seek licensure without delay.
While prohibitions against balance billing have been around for more than a decade, many healthcare providers still don’t understand their rights when it comes to collecting payment from patients and third-party payors.
Click here to read the rest of the article that appears in Florida Health Communications.