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Recent changes to the New York State Medicaid Program affect vaccine administration for pharmacies, claiming process for nurse practitioners, documentation requirements for transportation providers, and prior authorization for physical and occupational therapists. We summarize these changes below. Continue reading » The New Jersey’s Prescription Monitoring Program (NJPMP), aimed at halting the abuse and diversion of prescription drugs, was substantially updated recently to impose new requirements on prescribers of Schedule II drugs and, separately, to stiffen penalties for pharmacists failing to timely report information about dispensing of the controlled dangerous substance (“CDS”). Continue reading » Deniza Gertsberg, Esq. will be speaking during the upcoming NJSBA Health Law Section program on “Fundamentals of Medicare Provider Enrollment/Revalidation”. The program focuses on the steps in the Medicare enrollment/revalidation process and practical tips for successfully completing an enrollment/ revalidation, whether the attorney is submitting the 855 paper forms or using the Provider Enrollment Chain and Ownership System. The presentation will help attorneys and their clients submit enrollment and revalidations as accurately as possible the first time. Representatives of Novitas Solutions, Inc., a Medicare Administrative Contractor, whose role includes, among other things, analyzing Medicare enrollment and revalidation applications, will be presenting. Deniza Gertsberg, Esq. is one of the organizers of this New Jersey State Bar Association CLE program which is open to all members of the NJSBA’s Health Law Section. The presentation is scheduled for Thursday, September 10, 2015 at 6:00 p.m. at the New Jersey Law Center located at One Constitution Square, New Brunswick, NJ 08901. Login to register online. In a welcomed move, the Centers for Medicare & Medicaid Services (CMS) and American Medical Association (AMA) announced temporary freeze on certain sanctions and penalties during ICD-10 transition and the availability of additional resources to help physicians get ready for ICD-10. Continue reading » The Centers for Medicare & Medicaid Services (CMS) published full year of 2014 financial data about transfers of value by drug and medical device makers to health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion. The massive data release was done under the Open Payments program that was created by the Affordable Care Act. It requires drug and device makers to report transfers of value, including direct payments, as well as honoraria and research grants, to health care providers, as well as other industry-related providers. The role of this program is to shine a light of transparency on any conflicts of interest that exist in the medical marketplace and, as acting CMS Administrator Andy Slavitt said, “this is part of [a] larger effort to open up the health care system to consumers by providing more information to help in their decision making.” This is the second year of operation for the Open Payments system and it sports an improved web site with enhanced searching capabilities for easier data access. According to the CMS press release, CMS was able to validate nearly 98.8% of all records submitted drug and device makers, as well as group purchasing organizations, in the Open Payment system for all of 2013 and 2014. The system relies on health care providers to voluntarily review the compensation data submitted by companies and nearly 30% of the total value of the disclosed data was reportedly reviewed by registered physicians and teaching hospitals. The American Medical Association (AMA), the leading physicians’ organization, criticized the annual data release by CMS and warned that media should take caution in reporting on the information. “Media should verify the accuracy of data; understand the context of financial relationships between physicians and industry when reporting on Open Payments Data,” admonishes the AMA press release. CMS states that it plans to regularly update the Open Payments data to include changes from any data disputes and corrections made by health care providers and companies. We wrote in more detail about the Open Payments program in our past article. You may visit the Open Payments web site here: https://openpaymentsdata.cms. If you have any questions about Medicare or Medicaid participation or billing disputes, antikickback, or if you are a target of an investigation or an audit, please contact our office. Mandatory Electronic Prescribing Effective in NY. While the mandatory electronic prescribing was extended by Gov. Cuomo until March 27, 2016, e-prescribing for controlled and non-controlled substances is already available in New York for those meeting the regulatory requirements. Since 2011, NYS Medicaid Electronic Health Records Incentive Program has paid over $660 million in incentive funds within 17,144 NYS Medicaid Providers. With that much money distributed, providers should anticipate EHR incentive program audits. NYS Medicaid has begun revalidating hospitals, dentists, portable x-ray providers, chiropractors, nurse practitioners, physician assistants, nurses and mid-wives. The Office of the Civil Rights (OCR) within the US Department of Health and Human Services recebtly settled a HIPAA violation case with a single location compounding pharmacy in Denver, Colorado. This is yet another HIPAA settlement underscoring the importance of properly implementing and maintaining a compliance plan. Continue reading » New York State Medicaid has a new vendor to implement the new Medicaid Management Information System (MMIS) that will eventually replace the current vendor (eMedNY). The new vendor, Xerox State Healthcare LLC, won a five year contract with the State. Implementation of the new system will occur in two phases over an eighteen month period. Deniza Gertsberg’s article, Concierge Medicine: A Legal Analysis, was recently published in the New York State Bar Association’s Health Law Journal. Her article focuses on retainer-based medical practices examined through the lens of federal and state laws. This legal analysis evaluates the possible legal pitfalls that retainer-based medical practices may encounter with Medicare assignment rules, civil money penalties, healthcare exclusions, the Anti-kickback statute and the Medicare patient inducement statute. She also discusses the importance of understanding the scope of covered and noncovered Medicare items and services and further explores State insurance and managed care laws and ethical dilemmas presented by these forms of medical practice organization. Below is an excerpt from Deniza’s article:
For advice on transitioning or establishing a concierge medical practice please contact our office. In 2014, the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) reported “expected recoveries of over $4.9 billion.” The agency also excluded 4,017 individuals and entities and took 971 criminal actions. Similarly, the OIG pursued 533 civil actions against individuals and entities. According to the agency’s 2015 work plan, this year promises to be just as busy for the regulators. Continue reading » The mission of the Medicaid Fraud Division (MFD or Agency) within the Office of the State Comptroller is to prevent, detect, audit and investigate fraud, waste and abuse by New Jersey providers and recipients. As we look forward to the New Jersey Medicaid Fraud Division 2015 work plan, we analyze the agency’s 2014 activities. Continue reading » Deniza Gertsberg, Esq. will be speaking during “Elements of Fraud and Abuse Investigation” presentation. The event focuses on the basics of a New Jersey Medicaid fraud and abuse investigation. The topics that will be discussed include responding to subpoenas, self disclosure and the use of statistical sampling in audits. The Deputy Director of New Jersey Medicaid Fraud Division, Mark Moskovits and former Director of the Medicaid Fraud Control Unit, Riza I. Dagli will also be presenting. Deniza Gertsberg, Esq. is one of the organizers of this New Jersey State Bar Association event which is open to all members of the NJSBA’s Health Law Section. The presentation is scheduled for Thursday March 26, 2015 at 6:00pm at the New Jersey Law Center located at One Constitution Square, New Brunswick, NJ 08901. Login to register online. Last year, CMS issued a final rule which requires prescribers of Part D drugs to be either enrolled with Medicare or have submitted an opt-out affidavit to their Medicare Administrative Contractor (MAC) in order for a prescription to be eligible for coverage under the Part D program. See 42 CFR § 423.120(c)(5) and (6). Continue reading » |
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