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New York Health Care Law Blog

NY surgeon accused of misreporting surgical outcomes

The Department of Veterans Affairs’ (VA) Office of Inspector General (OIG) recently investigated a New York Veterans Affairs’ hospital. The agency’s investigation was prompted by allegations a surgeon employed at the hospital misreported surgical outcomes of cancer patients.

The government alleges the physician failed to properly perform an intraoperative radiofrequency ablation used for hepatocellular carcinoma. Physicians can use this procedure to remove cancerous tumors. The agency has accused the physician of failing to remove the tumor and failing to accurately report the results to patients. When questioned by patients about the presence of the tumor after the procedure was complete, the physician allegedly stated there was a recurrence.

Will the OIG make changes to the anti-kickback statute?

The law is always evolving. This is true whether discussing tax law, family law or the laws that impact health care. The tax code, for example, was the subject of the largest overhaul in recent history with the passage of the Tax Cuts and Jobs Act at the end of 2017.

This broad change to an area of law that is generally slow to evolve has led to questions about which laws could be next. Is it possible for such large reform within the laws that impact health care? The government has recently taken steps to indicate this could be possible.

Over 200 in Westchester and Rockland lost Medicare privileges

Medical professionals often rely on payments from Medicare for services provided to patients. The United States Department of Health and Human Service’s Centers for Medicare and Medicaid Services administers this program and requires medical professionals meet certain criteria to receive payment. In some situations, the government can choose to exclude a professional’s ability to request payments.

Such action is not uncommon and can cripple a medical facility. A recent report by LoHud found 230 medical professionals from Westchester and Rockland counties alone had lost this privilege.

DOJ accuses provider of failure to comply with investigation

The Department of Justice (DOJ) has petitioned the court to force provision of oral testimony deemed "relevant to a false claims law investigation." The government has accused a group that sponsors Medicare Part C insurance plans of "knowingly disregarding its duty to ensure the validity of data it submitted to Medicare for purposes of calculating" payments.

The government has sought testimony about three topics from corporate representatives to "expedite this investigation." The topics include questions about auditing procedures used to determine submitted diagnosis codes for four sample beneficiaries. Second, whether the polices, procedures and training regarding provider-submitted and chart review-generated diagnosis codes were valid and finally whether the personnel ensured compliance with these policies, procedures and training methods. The government questions whether the group investigated provider-submitted diagnosis codes unsupported by chart review results. It contends a failure to do so would support its allegations of a False Claims Act violation.

Does HIPAA really protect patients’ privacy?

Congress passed the Health Insurance Portability and Accountability Act (HIPAA) to help ensure the protection of patients’ medical records and personal health information. The rule sets boundaries on the use and release of medical records, established safeguards to help protect the information and holds those who violate these protections accountable for wrongdoing through the use of civil and criminal penalties.

The rule is one the federal government takes seriously through prosecution of violators. This was recently highlighted in a case that led to an oncology group paying $2.3 million to the United States Department of Health and Human Services (HHS) Office for Civil Rights for a violation of HIPAA.

Healthcare provider accused of upcoding

A data analytics firm has accused a healthcare provider of False Claims Act violations. The group states the provider illegally received payment for over $188 million in Medicare claims. If the suit is successful, the firm would receive a portion of the winnings.

The lawsuit is based on two primary allegations:

  • Secondary codes. The lawsuit claims the provider increased its bill to Medicare by adding secondary codes to Medicare claims. The provider allegedly used these codes solely for the purpose of increasing the cost of the claim.
  • Profitable diagnoses. The suit further contends the healthcare provider encouraged physicians to document diagnoses that would result in a high return. The provider allegedly gave medical professionals “tip sheets” to determine which secondary diagnoses were more financially profitable than others.

Effort to combat opioid abuse: Johns Hopkins provides guidance

The Department of Justice (DOJ) continues to crackdown on the illegal prescription of opioids. Attorney General Jeff Sessions has made clear his focus on opioid-related health care fraud and the prosecution of healthcare professionals that allegedly contribute to the problem. Enforcement efforts have led to the arrest and prosecution of medical professionals throughout the country. Although some have misused their role as a medical practitioner to illegally prescribe opioids for their own financial benefit, many faced false accusations of wrongdoing.

The government's continued focus on prosecution and enforcement efforts serves as a reminder for physicians to prescribe opioids carefully.

DOJ announces another regional Medicare Fraud Strike Force

The United States Department of Justice (DOJ) has announced another regional Medicare Fraud Strike Force to join the current forces in 10 cities throughout the country. Strike Forces are currently present in Brooklyn, Miami, Los Angeles, Detroit, Houston, Baton Rouge, New Orleans, Tampa, Chicago and Dallas.

The new division will cover the Newark, NJ and Philadelphia, PA areas.

Doctor gets 18 months prison time for healthcare fraud

The United States Attorney’s Office for the Southern District of New York recently announced the sentencing of a physician convicted for healthcare fraud. The government sentenced the physician to 18 months imprisonment, three years of supervised release and the payment of $103,843 in ill-gotten gains as well as $2,669,231 in restitution.

Building a case: The government gathers evidence

How will CMS’ proposed rule for 2019 impact hospitals?

The Centers for Medicare and Medicaid Services (CMS) recently filed its 2019 Medicare Inpatient Prospective Payment System (IPPS) proposed rule.

What is the IIPS? The IIPS is a system used by the government for payment of care provided by acute care hospitals. The government updates the rules used to govern this system on an annual basis.

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