The Health and Human Services Office of Inspector General (“OIG”) published a report in July of 2018 (“Report”) regarding weaknesses by Medicaid Managed Care Organizations (“MCO”) to identify fraud and abuse in the Medicaid program1. In general, the OIG found that MCOs lacked the controls and…
On June 1, 2018, the Delaware Board of Medical Licensure and Discipline (the “Board”) issued a Final Rule to add a new regulation to Title 24, Chapter 1700 of the Delaware Administrative Code in order to clarify certain terms used in the telemedicine and telehealth statute found at Title 24,…
This article summarizes many of the notable health care laws that were passed during the 2018 legislative session, which includes laws that are effective July 1, 2018, as well as laws that are effective after July 1, 2018. These laws affect both healthcare institutions, as well as individual…
On May 24, 2018, the Office of Inspector General (OIG) issued Advisory Opinion No. 18-03, which evaluated a proposed arrangement between a federally qualified health center look-alike (the “Provider”) and a county health clinic (the “County Clinic”), whereby the Provider would supply telemedicine…
On June 19, 2018, the Family and Social Services Administration’s (“FSSA”) Indiana Health Coverage Programs (“IHCP”) released provider bulletin BT201829 regarding revising the timely filing limit for Medicaid fee-for-service claims. Beginning January 1, 2019, Medicaid fee-for-service claims will be…
A recent Indiana case involving a non-compete in the healthcare field is worth review. In Great Lakes Anesthesia, P.C. v. O’Bryan, the Indiana Court of Appeals held that a restrictive covenant between an independent anesthesia group and two of its hospital-based CRNAs was unenforceable once the…
On May 17, 2018, the Family and Social Services Administration (“FSSA”) published a final rule, LSA Document #17-552 (“Final Rule”), to update and extend Indiana’s Hospital Assessment Fee (“HAF”) program.[1] The Final Rule amends 405 IAC 1-8-5 and 405 IAC 1-10.5-7 to extend the HAF program through…
The Joint Commission recently announced a new element of performance to Accreditation Participation Requirement APR.01.03.01 (“Element of Performance”). The Element of Performance requires immediate notification to The Joint Commission when the Centers for Medicare and Medicaid Services (“CMS”)…
On June 13, 2018, the Indiana Office of Medicaid Policy and Planning (“OMPP”) published a notice of intent (“NOI”) to adopt an administrative rule (“LSA #18-251”) that overhauls existing program integrity, Medicaid provider appeals, and Medicaid enrollment rules and requirements. The NOI states in…
On April 30, 2018, the Department of Health and Human Services, Office of Inspector General (“OIG”), issued an Advisory Opinion regarding an Arrangement whereby a Company that distributes and sells medical device and pharmaceutical products provides a limited number of sample ostomy products to…
In a May 25, 2018 notice, the Department of Healthcare and Family Services (the “Department”) announced a proposed change in the methods and standards by which the Department will reimburse providers for psychiatric and behavioral health services.[1] The proposed changes, effective for dates of…
A May 29, 2018 United States Attorney’s Office District of Minnesota press release reported that Wal-Mart Stores, Inc. and Sam’s West, Inc. (d/b/a Sam’s Club) have agreed to pay a total of $825,000 to resolve allegations that the stores violated the federal False Claims Act and Minnesota False…
