To Our Valued Clients:  Yesterday, as you likely know, the Governor of California issued an Executive Oder (the “Order”) related to COVID-19 and directing all California residents to “immediately heed the current State public health directives” regarding COVID-19.  The Order cited the Order of the State Public Health Officer which orders “all individuals in the State of California to stay home or at their place of residence except as needed to maintain continuity of operations of the federal critical infrastructure sectors…” The Order continued “[t]he federal government has identified 16 critical infrastructure sectors whose assets, systems, and networks…are considered so vital to […]

In February 2012, Aetna Life Insurance Company (“Aetna”) filed a lawsuit in Santa Clara County Superior Court against Bay Area Surgical Management, LLC (“BASM”). The case is captioned Aetna Life Ins. Co. v. Bay Area Surgical Management, LLC.  The outcome of the Aetna case is profound, and in my own practice, I have consistently warned physicians to be mindful of when they waive co-pays and deductibles, and to do so only in certain, limited circumstances. Just ask BASM, a moderately sized outpatient surgery practice which was tagged with a $37,400,000.00 jury verdict. The Aetna case is relatively dated, but the lessons will never stale. […]

California healthcare practices, including group practices and outpatient surgery centers, should brace for sweeping changes beginning on January 1, 2020, to the way they engage providers and staff, including nurses, physicians’ assistants, nurse practitioners, and technicians. At its core, Assembly Bill 5 puts a much greater burden on businesses to establish a worker is an independent contractor as opposed to an employee. According to the Los Angeles Times, “California’s bill is arguably the strongest of its kind in the nation, giving the state and cities the right to file suit against companies over misclassification, overriding the arbitration agreements that many […]

2014 Recently, the Office of Inspector General (the “OIG”), the enforcement arm for the United States Department of Health and Human Services (“HHS”)¹ , released its Fiscal Year 2015 Work Plan. Therein, the OIG “summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond.” Each year, the OIG publishes its Work Plan to categorize those areas of focus due to “limitations in the money appropriated to OIG.”  In 2015, the OIG will focus primarily on the billing, payment and quality of care issues with […]

By  Richard Haskin, Esq. The Centers for Medicare & Medicaid Services (CMS) released the 2015 final payment rule for ASCs and hospital outpatient departments (HOPDs) on Friday. The final rule can be found here: http://associationdatabase.com/aws/CASA/asset_manager/get_file/88319/medicare_2015_final_rule.pdf. ASC payment rates will increase by 1.4 percent in 2015. This increase is based on a projected rate of inflation of 1.9 percent minus a 0.5 percentage point productivity adjustment required by the Affordable Care Act. This payment update is higher than the 1.2 percent update in the proposed rule, which was based on an inflation rate of 1.7 percent minus a 0.5 percentage point productivity […]

An interesting question evolved several months ago upon creation of the Federal and State run insurance exchanges. Would payments stemming from private insurance companies participating in the public exchanges and accepting public subsidies now become subject to the Federal Anti-Kickback law, prohibiting the remuneration of consideration in exchange for services, referrals and the like? Providers felt sheltered from the Anti-Kickback law as long as the payment came from either a cash or private payor because the Federal law only extended to payments from Federal health programs. However, this assumption was now somewhat in flux with the creation of the public […]

2013   Last week, WellPoint, one of the nation’s largest insurers, settled a HIPAA violation case brought by the Department of Health and Human Services. In a self-reported violation, WellPoint was found to have exposed the personal information of over 612,000 individuals in what WellPoint termed a “lapse in its online security during a routine upgrade of its system.” The “lapse” occurred during a routine online upgrade of WellPoint’s tracking system. HHS said, in a statement, “This case sends an important message to HIPAA covered entities to take caution when implementing changes to their information systems, especially when those changes […]

2012 The Centers for Medicare and Medicaid Services (“CMS”) just released the new quality reporting codes, categorized as “G-Codes.” All ASCs are required to include these codes in all Medicare claim forms starting on October 1, 2012. The codes denote whether the patient suffered a burn, fall, other wrong including a wrong site, side, patient, procedure or implant event. Other items are included as well. Failure to include the G-Code in claim form will subject an ASC to reduction in Medicare reimbursements. More information and an explanation of the quality reporting codes from CMS can be found on the CMS […]