The Office of Inspector General Focuses on Nursing Home Abuse

The Office of Inspector General (OIG) released a special “Eye on Oversight” webinar series, which features top areas of interest for the OIG. Recently, the series presented by Regional Inspector General, General Brian Whitley, focused on nursing home abuse. The OIG reported that in 2016, there were more than 1,000 open nursing home abuse cases and that 85% of nursing homes reported at least one instance of abuse or neglect in 2016 alone. The OIG utilizes various tools to combat abuse and neglect in nursing homes including:

1.       Conducting Investigations;

2.       Exclusions;

3.       Corporate Integrity Agreements; and

4.       Recommendations to the Centers for Medicare and Medicaid Services (CMS) regarding nursing home abuse and neglect.

In past years, the OIG has made recommendations to CMS regarding the reduction of antipsychotics, which have been implemented through various education, guidance, and regulation revisions. The OIG reports a 30% reduction in abuse and neglect related to antipsychotics due to the recommendations made by the OIG.

Throughout the OIG's recent audits and reports including information gathered through partnerships with state Medicaid enforcement partners, the OIG found three common factors that contributed to the incidences of abuse in nursing homes:

1.       Lack of staffing including adequate and trained staff as well as sufficient supplies;

2.       Over medication of residents leading to negative quality of care outcomes including falls; and

3.       Individual bad actors, such as nursing assistants, who had previous criminal histories.

The OIG maintains that focusing on these areas may help nursing homes reduce deficiencies related to nursing home abuse and neglect. The Regional Inspector General also stated that the OIG will continue its efforts to root out fraud, hold wrongdoers accountable, and recommend solutions to better protect nursing home residents.

Justice Department Charges Hundreds in False Billing Schemes

More than 400 people, including doctors, pharmacists and nurses, have been charged in connection with a massive health care fraud scheme that cost the federal government of more than $1.3 billion, federal officials announced Thursday.

Read more at: http://www.ocregister.com/2017/07/13/hundreds-ensnared-in-justice-department-health-care-fraud-crackdown-on-1-3-billion-in-false-billings/amp/.

CMS Proposes Rule That Would Remove The Ban On Pre-Dispute Arbitration Agreements in Long Term Care

n June 8, 2017, the Centers for Medicare & Medicaid Services ("CMS") published a proposed rule that would remove the ban on pre-dispute arbitration agreements established in 2016. Under the new proposed rule, long term care facilities may enter into pre-dispute arbitration agreements as long as certain transparency requirements are met. CMS also proposes to remove the provision banning long term care facilities from requiring residents to sign arbitration agreements as a condition of admission.

Read more at: http://www.jdsupra.com/legalnews/cms-proposes-rule-to-reverse-pre-17362/

Compliagent's CEO, Nick Merkin, Interviewed on ABC News Re: Cyber-Security

On May 18, 2017, Compliagent's CEO, Nick Merkin, was interviewed on ABC News about the Wanna Cry virus and cyber-security.  Click here to learn more about protecting your IT data: https://youtu.be/Nf5RZAUVQ6s. 

No Business Associate Agreement? A $31,000 Mistake.

On April 20, 2017, the Office for Civil Rights (OCR) announced that the Center for Children’s Digestive Health (CCDH) paid $31,000 to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy rule. The settlement was initiated as a part of a compliance review following an investigation of a business associate, FileFax, Inc. FileFax stored records containing protected health information (PHI) for CCDH.

The investigation by the OCR revealed that the parties began sharing PHI since 2003 but neither party could produce a signed Business Associate Agreement (BAA) prior to October 2015.

The OCR has been reinforcing BAA requirements and has issued settlements with providers totaling $23 million in 2016. The Catholic Health Care Services of the Archdiocese of Philadelphia (CHCS) paid $650,000 as a settlement in 2016 as a result of lacking necessary BAAs. CHCS provided services to six skilled nursing facilities and the OCR received notification from each facility that a mobile device was stolen, potentially compromising 412 individuals' information. CHCS was found to have lacked the necessary BAA and did not conduct an accurate and thorough risk assessment of the potential risks and vulnerabilities of electronic protected health information (ePHI).

A BAA is not optional under HIPAA rules and regulations.  If you have a vendor who performs certain functions involving PHI/ePHI you must have a signed BAA in place to comply with the requirements under OCR.

Compliagent's Paige Pennington and Nick Merkin Deliver SNF Regulatory Update at SNF Boot Camp 2017

On April 24, 2017 Compliagent's Paige Pennington and Nick Merkin delivered the 2017 SNF Regulatory update on Physician Contracting in SNFs and The New Final Rule at the 2017 SNF Bootcamp in Downtown Los Angeles.  Other presenters included Cassie Dunham from the California Department of Health, as well as other government and industry experts.  

New Form For CMS Voluntary Self-Referral Disclosure Protocol

CMS issued a new Self-Referral Disclosure Protocol (SRDP) Form that provides a streamlined and standardized format for disclosing actual or potential violations of the physician self-referral law. The SRDP Form will reduce the burden on providers and suppliers submitting disclosures to the SRDP and facilitate our review of the disclosures.

Use of the form is mandatory effective June 1, 2017. Parties submitting self-disclosures to the SRDP are encouraged, but not required, to use the SRDP Form now. Visit the SRDP webpage to learn more.

Compliagent's CEO, Nick Merkin, Guests on a Special Episode of Healthicity's Podcast Series Entitled, "An Attorney Talks Compliance."

Nick Merkin, CEO of Compliagent, chats with compliance expert CJ Wolf from his office in sunny California about compliance from an attorney’s perspective.  

Merkin explained why it’s so important for organizations to see compliance from an attorney’s perspective. And how his unique point of view provides an additional layer of protection from compliance violations. In this compelling interview, Merkin explains how organizing compliance functions is, “worth its weight in gold.”

Tune in to this podcast, An Attorney Talks Compliance, to find out how to:

• Focus Compliance on Processes and Infrastructure

• Organize Compliance Functions to Protect Against Litigation

• Mitigate Legal Liabilities That Might Arise in Healthcare

Click here to listen and

to see compliance from an attorney’s perspective

OIG and HCCA Release Jointly-Prepared "Measuring Compliance Program Effectiveness: A Resource Guide"

On March 27, 2017 the OIG and HCCA released jointly-prepared guidance as to measuring the effectiveness of your organization's compliance program.  How effective is your compliance program?

Get your copy here: https://oig.hhs.gov/compliance/101/files/HCCA-OIG-Resource-Guide.pdf.  

Florida Court Imposes $347 Million in Treble Damages in SNF False Claims Act Whistleblower Case

On March 1, 2017, a Florida federal court imposed more than $347M in treble (three times) damages following a jury trial in a False Claims Act case. The four defendants operated 53 skilled nursing facilities and allegedly submitted false claims to Medicare and Medicaid. 

The whistleblower for the case was a former nurse at two of the facilities . The particular allegations involved submitting false claims and fraudulent records to substantiate the false claim asserting that patients needed and received more care than was necessary. 

Read more here: http://blog.providertrust.com/blog/false-claims-act-court-triples-whistleblower-damages