Mid-Atlantic Health Law TOPICS
Did You Know? - Winter 1998
Home Health Compliance. Did you know that the Office of Inspector General of the Department of Health and Human Services has issued a model voluntary compliance plan directed at home health agencies? This plan follows earlier compliance plans directed at clinical laboratories and hospitals. As with the earlier statements, the OIG insists that the plan does not contain mandatory provisions, but is rather a set of suggested guidelines.
Anti-Dumping. Did you know that the Department of Health and Human Services, Health Care Financing Administration, has issued new interpretive guidelines regarding the enforcement of the hospital anti-dumping law (Emergency Medical Treatment and Active Labor Act)? Covering issues made public by the media recently, the guidelines address situations where a patient presents with a possible emergency immediately outside the hospital building, or, alternatively, at a hospital clinic on a site some distance from the emergency department.
Insurance Defense Coverage. Did you know that an insurance company may have a duty under its general liability coverage to defend covered physicians against allegations of tortious interference with business relationships and antitrust allegations? The U.S. Court of Appeals for the 8th Circuit so ruled in a recent South Dakota Case.
Increased Fraud Audits. Did you know that the Health Care Financing Administration is preparing to hire new contractors to perform fraud and abuse audits? It is anticipated that the new contractors will review millions of carrier and intermediary claims, utilizing funds provided for this purpose by Congress.
Fraud and Abuse Targets. Did you know that the Office of Inspector General of the Department of Health and Human Services has issued a 1999 workplan targeting specific services for review? Among those targeted are: podiatry services, mental health services provided in nursing facilities, physician coding generally, and claims prepared and submitted by billing services.
Nursing Home Enforcement. Did you know that the Health Care Financing Administration is developing extensive plans to crack-down nationally on nursing facilities that do not comply with Medicare and Medicaid certification requirements? The Senate Special Committee on Aging is pushing the agency hard to show real signs of progress in this area.
Nursing Home Survey Information on the Web. Did you know that the Health Care Financing Administration has a new website that allows access to citations from the last survey of all U.S. nursing facilities? The Internet now displays a list of each requirement found "not met" on the latest survey, along with an identification of the scope and severity of the deficiency.
Hospital Outpatient Payment. Did you know that Medicare has published a proposed regulation providing for the creation of a prospective payment system for hospital outpatient services? The proposal bundles services into "ambulatory payment classes," and is expected to become effective "as soon as possible after January 1, 2000."
New Mandated Benefit. Did you know that, pursuant to the federal Women's Health and Cancer Rights Act of 1998, effective for plan years beginning on or after October 21, 1998, generally all employer sponsored health plans nationwide, whether insured or self-insured, must cover reconstructive breast surgery following a mastectomy, including surgery on the other breast to produce a symmetrical appearance, as well as cover prostheses and complications from the mastectomy? For more information, please contact: Barry F. Rosen
December 21, 1998