Monthly Newsletter

October 2022 Monthly Newsletter

HIPAA in Response to Hurricane Ian & Fiona

The State of Florida is under emergency declaration and public health emergency due to hurricane Ian. 


CMS announced additional resources and flexibilities in response to Hurricane Fiona in Puerto Rico. On September 20, HHS Secretary Xavier Becerra determined that a public health emergency exists in the commonwealth of Puerto Rico, retroactive to September 17.


Utilize OCR’s HIPAA Disclosures for Emergency Preparedness Decision Tool for guidance on disclosures for emergency preparedness. Click Here for how the HIPAA Privacy Rule applies in a public health emergency as outlined on OCR’S HIPAA Emergency Preparedness, Planning, and Response page.

Free Telehealth Webinars in October, 2022!

Center for Connected Health Policy (CCHP) Opens Registration for Free Webinars Soon


CCHP is a program under the Public Health Institute and the National Telehealth Policy Resource Center.  The CCHP website provides information on both Federal and State telehealth policy.


Save the date for these 2 October, 2022 free telehealth webinars sponsored by CCHP.  The first webinar covers issues related to practicing across state lines via telehealth, and the second looking toward the potential post-public health emergency (PHE) federal telehealth policy landscape. More detailed information and registration will be released soon – so save the date:


  • Friday, October 21, 2022 – 11 am – 12 pm PT
  • Friday, October 28, 2022 – 11 am – 12:30 pm PT

OIG Investigating Medicaid Managed Care Plan & Fraud Referrals

The Office of Inspector General (OIG) and Centers for Medicare & Medicaid Services (CMS) have ongoing concerns about managed care plans' efforts to combat fraud, including concerns about a lack of fraud referrals. This concern has resulted in a new OIG Work Plan Item to evaluate:

  • The number of potential fraud referrals managed care plans made to States, Medicaid Fraud Control Unites (MFCUs), and other entities;
  • Determine whether managed care plan processes support the referral of potential fraud; and
  • Identify the factors that influence whether managed care plans make referrals.

Click Here for more information on this Work Plan item. Review all OIG Active Work Plan Items.

 

$8.3 Million Pharmacy Fraud Scheme

According to the Sept 27, 2022 Department of Justice (DOJ) posting, Florida pharmacy owners paid kickbacks and bribes to telemarketers and telemedicine providers to secure orders for medically unnecessary prescriptions that were billed to Medicare.


Investor Michael Murphy and his co-conspirators also paid kickbacks and bribes to telemedicine companies that employed or contracted with physicians who signed the prescriptions. The physicians had no physician-patient relationship with the beneficiaries. Murphy pleaded guilty to one count of conspiracy to commit health care fraud. Murphy will be sentenced at a later date and faces a maximum of 10 years in prison. Read more about this case.

What is the Anti-Kickback Statute?

In some industries, it is acceptable to reward those who refer business to you. However, in the Federal health care programs, paying for referrals is a crime. The Anti-Kickback Statute or “AKS” is a criminal law, 42 U.S.C. § 1320a-7b(b) which prohibits the knowing and willful payment of "remuneration" to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients).


The statute covers the payers of kickbacks-those who offer or pay remuneration- as well as the recipients of kickbacks-those who solicit or receive remuneration. Each party's intent is a key element of their liability under the AKS. Criminal penalties and administrative sanctions for violating the AKS include fines, jail terms, and exclusion from participation in the Federal health care programs. Under the CMPL, physicians who pay or accept kickbacks also face penalties of up to $50,000 per kickback plus three times the amount of the remuneration.


Besides the AKS, the beneficiary inducement statute (42 U.S.C. § 1320a-7a(a)(5)) also imposes civil monetary penalties on physicians who offer remuneration to Medicare and Medicaid beneficiaries to influence them to use their services.  Learn more about the Anti-Kickback Statute, fraud and abuse by enrolling in the AIHC online Corporate Compliance program designed for health care providers.  This course addresses compliance in the following domains:

  • Ambulance Provider Guidance
  • Clinical Laboratory
  • DME Provider
  • Home Health Agency
  • Hospice
  • Hospital
  • Nursing Home (LTC)
  • Physician Office & Clinics
  • Third Party Medical Billing Company

Click Here to Register Online.  Click Here for free AIHC Compliance Articles.

Monkeypox 2022 Outbreak Update on Cases and Data

The Centers for Disease Control have recently updated information for Healthcare Professionals regarding interim clinical considerations for Monkeypox vaccination and other related information.  Monkeypox virus is part of the same family of viruses as variola virus, the virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder, and monkeypox is rarely fatal. Monkeypox is not related to chickenpox.  A Monkeypox case may be excluded as a suspect, probable, or confirmed case if:

  • An alternative diagnosis can fully explain the illness OR
  • An individual with symptoms consistent with monkeypox does not develop a rash within 5 days of illness onset OR
  • A case where high-quality specimens do not demonstrate the presence of Orthopoxvirus or Monkeypox virus or antibodies to orthopoxvirus

Clinical suspicion may exist if presentation is consistent with illnesses confused with monkeypox, such as secondary syphilis, herpes, and varicella zoster.  Click Here for more information, key characteristics for identifying Monkeypox, prevention and infection control.  Click Here for tracking of current U.S. Cases, U.S. Deaths and Global Cases. Read the AIHC article “Monkeypox: Coding & Documentation for U.S. Cases”.

2023 Medicare Part B Premium & Deductible

Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. For 2023, the standard monthly premium for Medicare Part B enrollees will be $164.90, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries in 2023 is $226, a decrease of $7 from the annual deductible of $233 in 2022.  For more details related to the 2023 Medicare Parts @ & B Premiums, Deductibles and Part D Income-Related Monthly Adjustments, read the CMS Fact Sheet.

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