Insurance Panel Abruptly Takes Up Provider Reimbursement Bill
House Insurance Committee Chair Daire Rendon (R-Lake City) began the process of passing legislation that penalizes auto insurers that are not fully compensating the providers of those taking care of people catastrophically injured in car accidents.
Although it wasn’t on the agenda, Rendon took up Rep. Ryan Berman’s (R-Commerce Twp.) HB 5870, which hits insurers acting in bad faith that don’t pay the bill sent to them by providers three times the amount of the overdue payment plus attorney costs.
She then took testimony from health care providers who claimed they hadn’t been compensated under the law for, in some cases, 10 months. They claimed they are having to take money out of their own pockets to make payroll.
The sudden change in the agenda caught fellow members and House leadership by surprise. It spurred several members, including Vice Chair Beau LaFave (R-Iron Mountain) and Republican Caucus Chair Matt Hall (R-Comstock Twp.) to walk out of committee. Berman’s bill didn’t move, but Rendon said she is interested in reporting it out in the future.
The Speaker’s office wasn’t aware the subject was being taken up, even though Speaker Jason Wentworth (R-Farwell) had said previously he’s not interested in taking up any major reforms to the state’s auto insurance this [Read More]
Why So Slow? Legislators Take on Insurers’ Delays in Approving Prescribed Treatments
By MICHELLE ANDREWS
Andrew Bade, who was diagnosed with Type 1 diabetes nearly two decades ago, is accustomed to all the medical gear he needs to keep his blood sugar under control. His insulin pump contains a disposable insulin cartridge, and a plastic tubing system with an adhesive patch keeps in place the cannula that delivers insulin under his skin. He wears a continuous glucose monitor on his arm.
Bade, 24, has used the same equipment for years, but every three months when he needs new supplies, his health insurance plan requires him to go through an approval process called prior authorization.
Getting that approval can take as many as three weeks, and Bade sometimes runs out of insulin before it comes through. When that happens, the resident of Fenton, Michigan, makes do with leftover preloaded insulin pens. They’re less precise than the pump, and he feels tired when he uses them. But they get him through.
“I don’t understand why they’re taking all this time to make these decisions and then they always say ‘yes’ anyway,” Bade said.
Michigan legislators in April sought to help patients like Bade by approving a law that sets standards meant to hasten that process. Beginning in June 2023, health plans will have to [Read More]
ON POINT WITH POs: Don’t Get Trained…Learn!
By EWA MATUSZEWSKI
While I may occasionally substitute the word training for learning, my strong preference when bringing professionals together to gain new insights is to focus on the learning that is taking place. Training too often connotes the visual of people gathered in a classroom being told from an “expert” how to tackle a particular issue or topic, while learning takes on a more comprehensive approach and includes sharing experiences among those assembled.
I broach this matter today because late last month, our organization sponsored a conference on Health Information Exchange (HIE) presented by Practice Transformation Institute and supported through a grant from BCBSM. A mainly in-person event, I attended virtually from New Hampshire where I was awaiting the birth of my first grandchild. (Yes, I can vouch for how wonderful grandparenting is, even from a distance!)
The conference objective was for participants to learn how the sharing of clinical and administrative data across the healthcare system contributes to improving patient safety, overall quality of care, public health and healthcare. Some topics included:
• Transforming care with connected teams
• What’s love got to do with HIT – how health information technology and the exchange of information between patients and providers is good for all
• Impacting the delivery of [Read More]
COMPLIANCE CORNER: The Provider Relief Fund Saga Continues
By STEPHEN SHAVER
Wachler & Associates, PC
The week of May 9, healthcare providers began to find out if their requests to file late reports under the Provider Relief Fund were granted. Providers whose requests were granted will have 10 days to file the required reports, while providers whose requests were denied can likely expect a repayment demand. These decisions are the latest chapter in the saga of the ever-shifting reporting requirements under the PRF.
Although initially intended to keep the nation’s healthcare providers afloat during the early days of the COVID-19 pandemic, the PRF has since descended into a bureaucratic labyrinth of compliance traps ready to snare the unsuspecting provider. The PRF is a $178 billion fund created by Congress through the CARES Act and currently administered by the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services. HHS has subdivided the PRF into various general and targeted distributions. These distributions were paid to providers in several waves between April 2020 and the present. Although there are currently dozens of types of distributions under the PRF, the highest value and most widely distributed payments were paid out to providers as general distributions in Spring and Summer 2020. These early payments included [Read More]
LEGAL LEANINGS: Continued IRS Attack On ‘Zero Out’ Of Profits
By RALPH Z. LEVY JR.
A prior article in this publication (IRS Attack on Zeroed Out Taxable Income in Recent Tax Court Cases) discussed the lessons that physician and other incorporated medical practice groups could learn from taxpayer losses in two then recent Tax Court cases in use of the “zero out” technique in the payment of compensation to the group’s owners. Under this approach, the practice group typically compensates its physician-owners or other licensed professional shareholders by payment of a portion of the anticipated pre-tax operating profits as compensation (salary) in regular increments during the tax year and then it will distribute the bulk of its profits in bonuses that are paid at year-end. For practice groups organized as ‘C’ corporations, the salary and year-end bonuses are deducted as compensation. As a result, the practice entity will pay little or no federal income taxes. The potential tax risk to this compensation method is that, depending on the facts and circumstances of each situation, the Internal Revenue Service (IRS) could disallow the compensation deduction for the “salary” and bonuses paid and treat these payments as non-deductible dividends made by the practice entity to its shareholders.
Two recent cases provide additional insight into how the zero out [Read More]
LANSING LINES
Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.
40% Of Health Clinics Saying No To Opioids
Doctors in Michigan are writing fewer opioid prescriptions, but the state’s death rate continues to climb. Also, more than 40% of the health care clinics have a sign on their doors: We do not prescribe opioids.
Those are two of the major takeaways from a three-hour presentation at the Spring Scientific Convention sponsored by the Michigan Osteopathic Association earlier this month.
A trio of physicians told the members that many doctors are “afraid” of being prosecuted by the state for alleged overuse of the addictive painkillers. To avoid any such action, they just stopped writing those scripts.
On any given day, 20% of the state’s adult population is experiencing chronic pain and the death rate from these overdoses has risen just over 9% last year and 170% in the last six years.
Dr. David Neff, who has been on the front line of the opioid crisis for years, reports a patient faces possible addiction after only seven to 10 days of taking the drug. For those who are addicted and are able to break the habit, he reported it can take up to four years for the human [Read More]
Senate OKs Easier Merges Between Independent Hospitals And Large Health Systems
Without opposition, the Senate greenlighted legislation designed to “streamline the process” allowing smaller-sized independent hospitals to partner with larger health systems, removing “redundant” barriers created by a 1945 act.
The principal stakeholder behind SB 944 was the North Ottawa Community Health System (NOCHS), which operates an 81-bed hospital in Grand Haven and—near the end of March—entered a non-binding letter of intent to discuss the feasibility of joining Trinity Health, according to a report from the Grand Haven Tribune.
In 1996, the six local municipalities formerly responsible for the NOCHS voted to transition it from the statute of an authority over to a 501(c)(3) organization.
SB 944 aims to eliminate the need for a public vote by authorizing a nonprofit corporation to sell, lease or otherwise transfer a hospital if the terms were approved by a hospital authority.
The termination of one of these hospital authorities could also be approved by a majority vote from its board.
“This legislation will streamline the process to allow North Ottawa to partner with a larger health system. By doing this, they can realize greater economies of scale, benefit from operational and clinical best practices and ensure that health care services are available in the local community for years to come,” said Steven Gilbert – [Read More]
The End of the COVID Emergency Could Mean a Huge Loss of Health Insurance
By ELISABETH ROSENTHAL
Now, as the pandemic’s acute phase seemingly draws to an end, millions of low-income and middle-income Americans are at risk of losing health insurance. The United States might see one of the steepest increases in the country’s uninsured rate in years.
When the federal COVID-19 public health emergency ends — as it is currently scheduled to on April 15, though it is likely to be extended — so will many of its associated insurance protections. That includes a rule forbidding states to kick anyone off Medicaid while COVID-19 raged, which came along with a 6.2-percentage-point boost in federal Medicaid funding to keep these most vulnerable patients insured.
Before the pandemic, states would regularly review people’s eligibility for Medicaid benefits and remove people who no longer qualified. But with that practice suspended, Medicaid enrollment has grown by more than 12 million since the beginning of the pandemic; as many as 1 in 4 Americans are now insured by the program.
When the public health emergency expires and the extra federal funds disappear, states will be required to once again review enrollees’ continued eligibility. Millions of people could be dropped in the process, as many as 15 million over time by some estimates. That includes people whose income [Read More]
ON POINT WITH POs: Make Diversity, Equity And Inclusion More Inclusive
By EWA MATUSZEWSKI
One of my most interesting, recurring roles as a healthcare CEO is to lead physicians, APPs, care teams and executives in a webinar series on implicit/unconscious bias under the umbrella focus of diversity, equity and inclusion. I initially developed an implicit/unconscious bias learning activity for Practice Transformation Institute and the Michigan Osteopathic Association and was recently asked by Blue Cross Blue Shield of Michigan to expand the curriculum. I am grateful for the opportunity to engage in meaningful dialogue on a subject I am passionate about.
One of my main goals in this series is to expand considerations of DEI and implicit/unconscious bias beyond race, gender and sexual orientation to include immigrants and non-native English speakers. Many readers may know of my Polish heritage (my surname provides a clue), but I am also an immigrant – albeit one who arrived as a babe in arms. Born in Mannheim, Germany to Polish parents, my father, mother, brother and I immigrated to the U.S. after World War II and made frequent trips back to Poland when the opportunity arose. My father, a captain in the Polish Army, had been a prisoner of war for five years. My Catholic mother had been a laborer in a Nazi [Read More]
COMPLIANCE CORNER: CMS’ Supplemental Medical Review Contractor Targets Vulnerabilities with Nationwide Medical Reviews
By JENNIFER COLAGIOVANNI, ESQ.
Wachler & Associates, P.C.
Meet one of the Centers for Medicare and Medicaid Services (CMS) newest contractors. CMS contracts with a Supplemental Review Contractor (SMRC) to help lower improper payment rates through audit and medical review activities. Noridian Healthcare Solutions, which is also a Medicare Administrative Contractor (MAC), was selected as the SMRC in 2018.
The SMRC conducts nationwide medical reviews for compliance with coverage, coding, payment, and billing requirements based on CMS-directed topic selections and timeframes. CMS assigns the focus project to the SMRC via a formal notification process. Review topics focus on issues identified through national claims data analysis from the Comprehensive Error Rate Testing (CERT) program, Office of Inspector General (OIG), and CMS internal data analysis, among others.
SMRC medical reviews, referred to as projects, fall within three categories: Healthcare Fraud Prevention Partnership Review, Program Integrity Review, and Provider Compliance Group Review. Each category has a slightly different focus:
• Healthcare Fraud Prevention Partnership (HFPP) Review: Based on fraud, waste, and abuse trends identified by the HFPP.
• Program Integrity (PI) Review: Focused on alleged possible falsification or other evidence of alterations of medical record documentation, including, but not limited to: obliterated sections; missing pages, inserted pages, or white out; excessive late entries; evidence [Read More]
LEGAL LEANINGS: Taking Care of Patients, and Taking Care of Yourselves
A brief look into the Good Faith Estimate rules of the No Surprises Act, the National Crisis Hotline, and the New Act Promoting Mental Health among Health Care Professionals
By ERICA A. ERMAN
No Surprises Act: Behavioral Health Considerations Regarding the Good Faith Estimate Provisions
With the passage of the No Surprises Act, effective January 1, 2022, providers and facilities are now required to provide Good Faith Estimates to uninsured and self-pay individuals detailing the cost of the primary service or item needed and the cost of services or items that are customarily provided in conjunction with that primary item or service. This is relevant across the entire health care sphere, but is of particular importance in the behavioral health care world because many behavioral health patients are uninsured or choose to self-pay.
The requirements of the Good Faith Estimate provisions are triggered when an individual is either (1) scheduling a procedure or service, or (2) asking for information about a service or procedure—even if it is not being scheduled at that time. No magic words are required; after asking the individual if they are uninsured or planning on not using their insurance—if the individual says yes—the provider or facility must inform the individual of the availability of a [Read More]
LANSING LINES
At-Home Care Provider Believes $400 Insurance Refund Was Inflated
Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.
An at-home care provider for catastrophic car accident survivors is accusing the governor of “inflating and expediting” the $400 per-vehicle refunds, claiming it was inappropriately calculated as “a political favor.”
Based on his calculations, Bob Mlynarek, the co-owner of 1st Call Home Healthcare, said the Michigan Catastrophic Claims Association (MCCA) should have limited the reimbursement to $78 per driver in order to stay in line with the state law that lays out the calculations under which a refund is triggered.
“You tell me in the insurance code or the MCCA Plan of Operation where it says that the MCCA can just give out whatever they want as long as they think that they can maintain continuity of care. That’s not what the statute says,” Mlynarek said. “I checked with three different attorneys. I’m right. They did not follow the law.”
MIRS reached out to a spokesperson for the Coalition Protecting Auto No-Fault (CPAN) for a quote on the MCCA’s refund calculation. They also pointed to Mlynarek’s research on the topic.
DIFS Communications Director Laura Hall expressed that the law Mlynarek is pointing toward exists set a refund in [Read More]
Shirkey Says It’s Time To End COVID Testing ‘Obsession’
As barrels of at-home COVID-19 tests wait to be picked through and new daily COVID-19 case numbers continue to decline, Michigan’s Senate Republican Leader is calling on the state to “back off on our obsession on testing.”
“. . . Especially since Omicron remains the dominant strain,” said Senate Majority Leader Mike Shirkey (R-Clarklake). “Too many false positives. And negative tests often cause people (with symptoms) to unintentionally spread other viruses like the flu. If you’re sick, stay home.”
Michigan’s Department of Health and Human Services reported 1,656 new cases of the virus since the report on March 4, as well as 16 deaths due to the virus.
A seven-day positive rate of 4.86% – with average per-day diagnostic testing up from around 50,000 to 60,000 – was the lowest it’s been since July 2021. Additionally, there were 777 adults hospitalized with a confirmed case of COVID-19, which is down by nearly 83% from December 2021, when there were 4,504.
Shirkey has been recognized for his head-turning comments on COVID-19 – from criticizing lockdowns to promoting natural immunity. He continues to say the early COVID-19 isolation orders of 2020 were “more costly in lives and livelihoods than COVID itself” and that the cost-benefit of vaccines is still unfolding.
“History has [Read More]
COVID’s ‘Silver Lining’: Research And Breakthroughs
By LIZ SZABO
The billions of dollars invested in COVID vaccines and COVID-19 research so far are expected to yield medical and scientific dividends for decades, helping doctors battle influenza, cancer, cystic fibrosis, and far more diseases.
“This is just the start,” said Dr. Judith James, vice president of clinical affairs for the Oklahoma Medical Research Foundation. “We won’t see these dividends in their full glory for years.”
Building on the success of mRNA vaccines for COVID, scientists hope to create mRNA-based vaccines against a host of pathogens, including influenza, Zika, rabies, HIV, and respiratory syncytial virus, or RSV, which hospitalizes 3 million children under age 5 each year worldwide.
Researchers see promise in mRNA to treat cancer, cystic fibrosis, and rare, inherited metabolic disorders, although potential therapies are still many years away.
Pfizer and Moderna worked on mRNA vaccines for cancer long before they developed COVID shots. Researchers are now running dozens of clinical trials of therapeutic mRNA vaccines for pancreatic cancer, colorectal cancer, and melanoma, which frequently responds well to immunotherapy.
Companies looking to use mRNA to treat cystic fibrosis include ReCode Therapeutics, Arcturus Therapeutics, and Moderna and Vertex Pharmaceuticals, which are collaborating. The companies’ goal is to correct a fundamental defect in cystic fibrosis, a mutated protein.
Rather than [Read More]
ON POINT WITH POs: Behavioral Health Crisis Puts Spotlight on Value of Social Worker Role
By EWA MATUSZEWSKI
I’ve been writing this column for years now and have given appropriate kudos to a variety of disciplines within the healthcare realm. But I’m not sure I’ve explicitly called out social workers for the tremendous value the profession brings to healthcare, specifically as it relates to the behavioral health component of primary care.
I’ve been a personal supporter and advocate of social workers as far back as 20 years ago, when the Medical Network One CMO’s primary care practice used their services to help coordinate community resources for patients with needs beyond traditional medical care. Our physicians organization also included social workers in our Community Care Travel Teams (CCTT) which we launched in the mid 2000’s to bring a multi/cross-disciplinary team of healthcare professionals into the primary care setting to help physicians better serve patients with chronic conditions and multiple co-morbidities.
So, what is the impetus for publicly singling out social workers for admiration now? I think our nation’s collective emotional health was teetering before the pandemic. As we emerge from lockdowns, remote learning and working, and job and family juggling amid a hyper-partisan environment and a frightening war, we are all hurting in our own way to varying degrees. Increasingly, though, we appear to [Read More]
COMPLIANCE CORNER: Michigan Ramps Up Efforts To Recruit And Retain Providers During COVID-19
By JESSE A. MARKOS, Esq.
Wachler & Associates, P.C
The outbreak and continuation of the COVID-19 pandemic has stretched the staffing resources of Michigan’s health care system to unprecedented levels. Adding to the demand for already scarce health care providers, hospitals have scrambled to find additional frontline workers like emergency medicine physicians and nurses. During this period of mounting workforce shortage, Michigan has taken significant steps to enhance efforts to recruit and retain health care providers.
For example, on Feb. 16, 2022, Gov. Gretchen Whitmer signed a new law approving $1.2 billion in federal aid money for COVID-19 relief efforts. Importantly, $300 million of that federal aid has been earmarked to address the shortage of health care providers. In a tweet sent the same day, Gov. Whitmer stated: “The bill I signed today is a testament to what’s possible when Republicans and Democrats work together to put Michiganders first…and make healthcare more accessible.” This new law gives the Michigan Department of Health and Human Services the ability to offer certain cash recruitment and retention bonuses, student loan payment assistance or tuition assistance, and reimbursement for certain training in order to attract and retain health care providers.
This federal aid to help recruit providers has not been the only action [Read More]
LEGAL LEANINGS: How Application Programming Interfaces Apply to Healthcare Entities
By EMMA TRIVAX, Esq.
ONC Final Rule
Information blocking
On May 1, 2020, the Federal Department of Health and Human Services (“HHS”), Office of the National Coordinator for Health Information Technology (“ONC”) released a Final Rule (the “ONC Final Rule”), which implements the information blocking provision of the 21st Century Cures Act, enacted in 2016. The information blocking provision applies to health care providers, health IT (“HIT”) developers, and health information exchanges/networks (“HIEs”).
“Information blocking”, in this context, refers to actions that discourage or interfere with the interoperability of electronic health information (“EHI”) except when necessary to comply with laws, such as HIPAA. An example of a common instance of information blocking is when healthcare entities charge patients unreasonable fees for copies of their electronic medical record. Ultimately, information blocking hinders the desired full interoperability and exchange of EHI.
ADI/FHIR Implementation
In order to enhance interoperability and prevent information blocking, the ONC Final Rule requires that certain technical certification criteria be implemented. The ONC Final Rule affects various kinds of healthcare entities, but HIT developers are the most heavily impacted. Although many HIT developers understand the generalities of the ONC Final Rule, many HIT developers are now struggling to understand the requirement that HIT developers must ensure their HIT is in [Read More]
LANSING LINES
Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.
MDHHS Continues COVID-19 Vaccine Push As Deaths Diminish
The Michigan Department of Health and Human Services released a weekly list of COVID-19 vaccination clinics as it continues to report a low number of new deaths from the virus.
The state health department reported 1,423 new COVID-19 cases and eight deaths over a three-day period. The average number of cases per day has plateaued, but the number of deaths continue to drop. Over the last three days, Michigan has reported only eight deaths due to COVID, the lowest death numbers since the July 4 holiday last year.
A list of vaccine clinics was released, and the COVID-19 dashboard indicates there are 4,296 sites across Michigan that offer one of the three vaccines.
The state vaccination rate has stagnated between 66% and 67% for months.
The number of vaccines delivered to the state has also decreased as the number of cases has decreased.
Family Doctors Shortage Pegged At 269, Growing
Gone are the days of family doctors making house calls to patients, but a group of family doctors announced that even primary care physicians for many communities across Michigan are becoming a rare sight.
There are 3 million Michiganders in mostly [Read More]
COVID Still Threatens Millions of Americans. Why Are We So Eager to Move On?
By VICTORIA KNIGHT
Iesha White is so fed up with the U.S. response to COVID-19 that she’s seriously considering moving to Europe.
“I’m that disgusted. The lack of care for each other, to me, it’s too much,” said White, 30, of Los Angeles. She has multiple sclerosis and takes a medicine that suppresses her immune system. “As a Black disabled person, I feel like nobody gives a [expletive] about me or my safety.”
The Centers for Disease Control and Prevention has a strict definition of who is considered moderately or severely immunocompromised, such as cancer patients undergoing active treatment and organ transplant recipients. Still, millions of other people are living with chronic illnesses or disabilities that also make them especially susceptible to the disease. Though vulnerability differs based on each person and their health condition — and can depend on circumstances — catching COVID is a risk they cannot take.
As a result, these Americans who are at high risk — and the loved ones who fear passing along the virus to them — are speaking out about being left behind as the rest of society drops pandemic safeguards such as masking and physical distancing.
Their fears were amplified this month as several Democratic governors, including the leaders of California [Read More]
DHHS Wants $386.1M One-Time For Behavioral Health Services
The state’s health department is requesting a one-time $386.1 million cash pump into behavioral and public health services, with more than 84% of the deposit going into a new state-operated psychiatric complex.
The Senate Health and Human Services Appropriations Subcommittee hosted its first hearing for the Fiscal Year 2023 budget this month.
In the governor’s $74.1 billion proposed budget for the new fiscal year, $325 million would be infused into a new state psychiatric facility complex, which would replace the 66-year-old Hawthorn Center and the 43-year-old Walter P. Reuther Psychiatric Hospital as a single campus.
“This new facility will be used to provide treatment, care and services to children and adults with severe mental illness,” said Elizabeth Hertel, the director of the Michigan Department of Health and Human Services (DHHS). “We would expect the build of this facility to take around four or five years at a minimum.”
Currently, the Hawthorn Center in Northville is the sole state-run psychiatric hospital for pediatric patients – and with 55 beds authorized by the state for treating youths, admittance is often weighed down by a waitlist.
The governor also proposed spending an extra $15.2 million of FY 2022 dollars and $10.5 million in FY 2023 to open up new units at the Hawthorn [Read More]
IN OUR VIEW: HIV And COVID: A Tale Of Two Crises
By PAUL NATINSKY
A few weeks ago, I had the pleasure of watching my 14-year-old daughter compete in a soccer exhibition before college coaches and scores of weary, but supportive parents. New teams and new parents crowded the hallways and sidelines of the indoor venue waiting for their turns. There was not one masked face in the place.
The next day, I enjoyed the sublime tones of my 18-year-old oboist daughter performing on the tightly packed stage at Orchestra Hall in Midtown Detroit with close to 100 fellow musicians and the customary crowd of assembled parents, some with grandparents in tow. Admission required a current vaccine card and a mask.
I would venture that many parents have encountered such wild juxtapositions of COVID policy during the past few months. That it makes absolutely no sense as a disease containment strategy should not come as a surprise. And it has little to do with the politicization of the current pandemic.
Take, for example, the initial response to AIDS/HIV as it boomed into the national consciousness in the 1980s. In the early days of that virus it was thought to be a death sentence. There was no vaccine (even still) and early treatments like AZT were thought by some to be [Read More]
ON POINT WITH POs: An HIT Primer For Physician And APP Practices Planning Tech Purchases In 2022
By EWA MATUSZEWSKI
I was recently asked to comment on best practices for physicians and Advance Practice Providers (APP) considering the purchase of new technology for their independent practice. With 2022 still largely ahead of us, it’s good timing for a topic that may be on your business to-do list this year. Let me first start with an admitted bias. I love technology and have always been an early adopter, whether it was a Palm Pilot, BlackBerry, smartphone, Kindle, iPads or videoconferencing (long before the pandemic). Yet, I know that purchasing tech on a broader scale, namely software for healthcare practices, can be difficult and user non-friendly. (Well, perhaps that last comment is a veiled reference to my ongoing frustration at the lack of interoperability of various healthcare software platforms and reporting systems.)
The evolution of technology demands its ongoing consideration, and it’s important to note that, in large part, patients-consumers are driving the need for new healthcare IT. While telehealth comes to mind, several of our own members’ practices (non-ophthalmologists) have been doing retinal eye exams using digital retinal cameras for several years now. In general, there is an ever-growing area of patient-facing products, including those for continuous glucose, weight, blood pressure and EKG remote monitoring, [Read More]
COMPLIANCE CORNER: Data Breaches: No Harm, No Foul
By ROLF LOWE
In the past few months there have been two Federal District Court rulings addressing lawsuits brought in part on an alleged disclosure of Personally Identifiable Information (PII) and/or Protected Health Information (PHI) protected under the Health Insurance Portability and Accountability Act (HIPAA). In the rulings, the Courts have relied on a recent Supreme Court ruling on a case involving a class action lawsuit alleging violations of the Fair Credit Reporting Act (FCRA) issued in the spring of 2021.
The Supreme Court case, titled Ramirez v. TransUnion, arose out the named plaintiff, Sergio Ramirez, being placed on a list maintained by the Treasury’s Department’s Office of Foreign Assets Control (OFAC) of people with whom United States companies cannot do business because they have been flagged as being either terrorists, drug traffickers or serious criminals. Ramirez’s credit report with TransUnion contained inaccurate information and TransUnion eventually removed the OFAC alert from any future credit reports that might be requested by, or on behalf of, Ramirez. The class action lawsuit brought by Ramirez and others similarly situated against TransUnion was premised on the fact that the class members’ credit reports contained misleading information and the information was disseminated to the third parties. The Supreme Court dismissed a [Read More]
LEGAL LEANINGS: New EKRA Interpretation Provides Some Guidance In Its Application
By JEREMY BELANGER
On Oct. 24, 2018, the Eliminating Kickbacks in Recovery Act (EKRA) was enacted. Broadly speaking, EKRA prohibits soliciting, receiving, paying, or offering “any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind,” for referring or to induce a referral to a recovery home, clinical treatment facility, or laboratory, as those terms are defined in EKRA. While modeled after the federal Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b), EKRA applies more broadly to any public or private plan or contract providing medical benefits, items, or services. EKRA is a criminal statute enforced by the U.S. Attorney General. A violation of EKRA may result in a fine of $200,000, up to 10 years imprisonment, or both for each violation.
EKRA contains several statutory exceptions. Among them are:
[A] payment made by an employer to an employee or independent contractor (who has a bona fide employment or contractual relationship with such employer) for employment, if the employee’s payment is not determined by or does not vary by–
(A) the number of individuals referred to a particular recovery home, clinical treatment facility, or laboratory;
(B) the number of tests or procedures performed; or
(C) the amount billed to or received from, in part or [Read More]
LANSING LINES
Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.
MDHHS: Masks No Longer Needed At Schools, Indoors
Department of Health and Human Services officials announced that it is dropping the suggestion that masks be worn in schools or indoors as COVID-19 cases continue to fall.
The health department reported 4,271 new cases and 312 new deaths of COVID-19 over a two-day period this month. The two-day average of cases was 2,136, marking a decline in new cases across the state.
The report prompted the health department to revise guidance for wearing masks indoors to prevent the spread of the virus.
“This is good news for Michigan,” Gov. Gretchen Whitmer said. “While Michigan hasn’t had statewide mask policies since last June, this updated guidance will underscore that we are getting back to normal. Let’s keep working together to build on our momentum so we can keep our kids learning in person.”
The guidance would not be dropped for nursing homes, homeless shelters, jails, prisons and other health care facilities. Officials also still recommended masks for people in isolation or quarantine after exposure to COVID-19.
Health department officials stated that school administrators and other organizations should continue working with county health departments to determine local risk for school.
Michigan [Read More]