The False Claims Act (“FCA” or “Act”) is a federal anti-fraud statute that protects against persons and companies defrauding the government. The Act has been dubbed the government’s “primary litigation tool for recovering losses resulting from fraud.” The FCA imposes civil liability on any one who “knowingly presents…a false or fraudulent claim for payment or approval” to the federal government. It is used extensively to protect against fraud in healthcare.
The Department of Justice designated 12 federal prosecutors across the country as part of the Opioid Fraud and Abuse Detection Units. These Units are assigned to areas where the most opioid drug-related deaths have occurred: California, Nevada, Alabama, Central Florida, East Tennessee, West Virginia, North Carolina, Kentucky, Ohio, Pennsylvania, Michigan, and Maryland. Members of these Units also includes numerous federal, state, and local law enforcement and governing entities including the DEA, FBI, HHS, and other federal and state agencies (Medicaid Fraud Control Units, FDA, IRS, State Pharmacy Boards, etc.). These Units have a specific mandate to target physicians, pharmacists, and ancillary services (addiction treatment centers, etc.).
A look at the calendar tells us that we only have a short time left in 2018. That means many practices will be looking to complete their Security Risk Assessments in order to either qualify for the 2018 Merit-based Incentive Payment System (MIPS) or to simply fulfill their obligations to comply with the HIPAA Security Rule.
Where are the old (and not so good) days when a patient with myocardial infarction was staying in hospital bed for a week?
At the core of the Affordable Care Act (ACA) is the three-legged stool: (1) insurance reforms; (2) the individual mandate; and (3) premium and cost-sharing subsidies. Removal of any one of these legs could destabilize the ACA. The ACA established insurance marketplaces in every state to provide access to ACA compliant private health insurance coverage (Qualified Health Plans) in the individual and small group markets. The ACA provides premium subsidies on a sliding scale for persons with incomes up to 400% FPL for the purchase of an individual policy on the marketplace exchange. It also provides cost-sharing subsidies for persons with incomes below 250% FPL. Prior to the implementation of the ACA, manual rating was typically used by insurers for rate-making in the individual and small group markets and exclusions from coverage for pre-existing conditions were common. Age-based rates were typically 5:1. The insurance reforms in the ACA are largely directed at the small group and individual markets (e.g., guaranteed issue/renewal, no preexisting condition limitations, adjusted community rating capped at a 3:1 ratio for age). Standardization of benefits is achieved by requiring coverage for ten essential health benefits (EHBs) and certain preventive services which in the latter case services must be provided without cost-sharing.
Physicians serve on the frontlines of our healthcare system, and by extension the many social programs guaranteed by the Social Security Administration. It’s a large responsibility and we owe them a debt of gratitude. These dedicated care providers, across many areas of practice and at varied levels within our medical system, help more than 57 million children and adults who live with disabilities across the United States.
Every year, new hearing aid technology is introduced to the market. New technology in hearing aids boasts updates and changes in directional microphones, sound processing algorithms, noise reduction features, amplitude and frequency compression, and audio data transfer between hearing aids, just to mention a few. What is often forgotten however, is that the primary objective of a traditional hearing aid fitting is to ensure that the patient is receiving the appropriate amount of amplification for their hearing loss at each frequency.
Healthcare professionals are all well aware of what a clinical trial is, how they work, and the possibilities that are provided to those who participate. However, the majority of Americans have not participated or heard about opportunities to participate in clinical research. According to a survey conducted by Research!America in partnership with Zogby Analytics (2017), fewer than 10% of Americans actually participate in clinical trials. Digging further into the reasons why, 55% of those surveyed stated that they were not aware or lacked information regarding clinical trials (Research!America, 2017).
The internet is a necessary part of the healthcare world today. This forces us to deal with the issue of managing employee Internet usage which can be a drain on your organizations productivity. This holds true in the healthcare industry whether you run a small clinic, large practice or hospital.
Social Security Disability under Title II of the Social Security Act*
Surveys have shown that most Americans know little about Social Security law and the vital benefits it provides. By far, the least understood Social Security benefit is Social Security Disability Insurance (SSDI). This lack of knowledge has been measured through objective testing in various academic studies. Anecdotally, I know this to be true based on recurring questions and comments I have received from the public and clients alike over the last several decades of my work as a social security disability attorney.
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