BREACH OF CONTRACT
DENIAL OF APPLICATION FOR PRIVILEGES
DISABILITY AND SEX DISCRIMINATION
EXHAUSTION OF ADMINISTRATIVE REMEDIES
FALSE CLAIMS ACT
FALSE CLAIMS ACT/ANTI-KICKBACK STATUTE
FALSE CLAIMS ACT – STARK LAW
REVOCATION OF STATE LICENSE
WRONGFUL TERMINATION (RESIDENT)
YOUR GOVERNMENT AT WORK
Revised, Draft NPDB Guidebook Open for Public Comment
On November 22, 2013, the Department of Health and Human Services (“HHS”) Health Resources and Services Administration posted a notice on its website that a draft, revised version of the National Practitioner Data Bank (“NPDB”) Guidebook is available for public comment. Instructions on how to obtain a copy of the revised Guidebook and submit comments are available here.
Final Rule on 2014 Hospital Outpatient Prospective Payment System (“OPPS”)
On November 27, 2013, CMS filed a final rule with comment period on, among other things, the 2014 Hospital OPPS. According to CMS, the rule encourages “more efficient delivery of outpatient facility services by packaging the payment for multiple supporting items and services into a single payment for a primary service similar to the way Medicare pays for hospital inpatient care.” The rule also discusses information-gathering on off-campus, provider-based departments. A press release for the rule can be found here and the actual rule can be found here.
Proposed Rule on PSOs
Earlier this week, HHS and the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule on certain aspects of the Patient Protection and Affordable Care Act, including a requirement that hospitals with 50 or more beds, to be eligible to provide services to individuals with health plans purchased on the exchanges, establish a Patient Safety Evaluation System and contract with a Patient Safety Organization (“PSO”) by January 1, 2015. The rule proposes to delay the deadline for this requirement because, among other things, “it is not entirely clear that there is sufficient capacity to enable all hospitals subject to this provision to contract with a PSO at this time.”
OIG Advisory Opinions 13-17, 13-18, and 13-19
In the last couple of weeks, the Office of Inspector General (“OIG”) was busy issuing advisory opinions. In Advisory Opinion 13-17, the OIG addressed a county’s proposal to use taxes to cover out-of-pocket amounts owed by non-residents for county-owned ambulance services. The OIG concluded that the arrangement would not constitute grounds for the imposition of civil monetary penalties, nor would it impose administrative sanctions under the Anti-Kickback Statute. In Advisory Opinion 13-18, the OIG reviewed an ambulance supplier’s response to a request for proposals from a city for the provision of ambulance services. The OIG determined that the supplier’s proposal to defer to its compliance officer’s decisions on donating certain equipment to the city could potentially generate prohibited remuneration under the Anti?Kickback Statute and be grounds for administrative sanctions because the decisions would not be based on objective criteria. Advisory Opinion 13-19 discussed a proposal from a supporting organization of a charitable organization to provide premium assistance to patients with a rare genetic disorder who are in financial need. The OIG concluded that the arrangement was not grounds for civil monetary penalties or administrative sanctions under the Anti?Kickback Statute.
CMS Advisory Opinion No. CMS-AO-2013-03
Last month, CMS issued a favorable advisory opinion to a physician-owned hospital proposing to add observation beds. CMS concluded that the proposal would not violate the limitation, contained in the whole-hospital exception of the Stark Law, on the expansion of capacity in physician-owned hospitals.
Final Rule on 2014 Physician Payment Rates
On November 27, CMS issued a final rule with comment period on the 2014 physician fee schedule. According to CMS, the rule includes “a major proposal to support care management outside the routine office interaction as well as other policies to promote high quality care and efficiency in Medicare.” The press release on the final rule can be found here and the actual rule here.