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Husch Blackwell welcomes Associate Wakaba Y. Tessier to the firm’s Healthcare group in St. Louis. Tessier has concentrated her practice in healthcare law since obtaining her J.D. in 2009, and prior to that worked in the healthcare industry for a pharmaceutical consulting firm.

Husch Blackwell’s Healthcare team continues to expand with Tessier as the fifth addition to the group this year. Emily Park joined the Jefferson City office in September upon receiving her J.D. from the University of Missouri School of Law. Kansas City Partner and former Health and Human Services Senior Counsel Brian Bewley, along with St. Louis Associate Kimela West, joined the firm in July. West had practiced at another firm in St. Louis where her clientele included a major health system with more than 20 hospitals, home health agencies and assisted living facilities. Initiating the hiring trend was Former Hospital Risk Management Director Tina Boschert, who joined the Kansas City office in May.

The American Health Lawyers Association (”AHLA”) noted today the following:  CMS Launches Initiative To Reduce Avoidable Hospitalizations Among Nursing Home Residents 

The Centers for Medicare & Medicaid Services (CMS) announced September 27 cooperative agreement awards to implement a new initiative aimed at reducing avoidable hospitalizations among nursing facility residents.

The awards to seven organizations—Alabama Quality…

On September 25, 2012, two members of the Husch Blackwell Healthcare team, Brian Bewley and David Pursell, presented a webinar discussing:

  • An overview of Stark
  • Stark overpayment reporting requirements
  • Steps to take after discovering a potential Stark violation

As former Senior Counsel in the Office of Inspector General for Health and Human Services and…

In less than two weeks, CMS will begin reducing a hospital’s Medicare reimbursements by as much as 1% if the hospital’s readmission rates are too high.  This reduction is part of a program authorized by the Affordable Care Act called the Hospital Readmissions Reduction Program.  You can read more about the program CMS’s website.

Nearly 1…

In August, the Office of Inspector General (OIG) of the U. S. Department of Health and Human Services released a report describing inappropriate and questionable billing by home health agencies.  The OIG conducted the study because recent investigations and studies showed that home health agencies are vulnerable to fraud, abuse, and waste.  The OIG identified inappropriate claims by examining claims data from home health, inpatient hospital, and skilled nursing facilities.  The OIG also looked at HHAs that billed unusually high amounts according to at least one of its six measures of questionable billing.  The report determined that Medicare inappropriately paid $5M for home health claims with three specific errors in 2010.  To read the report, click here.

Attorney Elizabeth Hogue prepared a concise, helpful summary of the report as follows:

The OIG issued Report OEI-04-11-00240 in August, 2012, entitled “Inappropriate and Questionable Billing by Medicare Home Health Agencies.” Unlike some other guidance published the OIG, this Report provides detailed information about inappropriate and questionable billing practices by home health agencies (HHA’s). Specifically, the OIG concluded that HHA billing is questionable or unusually high on the six measures below, if greater than the 75th percentile plus 1.5 times the interquartile range. The six measures are as follows:

 1. High average outlier payment amounts per beneficiary

According to the OIG, HHA’s with outlier payments above $403 per beneficiary have unusually high outlier payments and are likely engaging in questionable billing practices.

A client recently asked me to review its fall policies and procedures as they relate to the standard of care.   Because that project was on my mind, the new training modules for nurse aides in long term care that were recently published by the Agency for Healthcare Research and Quality (AHRQ) caught my eye.  The three published modules are:

  1. Module 1: Detecting Change in a Resident’s Condition
  2. Module 2: Communicating Change in a Resident’s Condition; and
  3. Module 3: Falls Prevention and Management

Each module has an instructor’s guide and a student workbook that includes training materials, summaries and “Pearls and Pitfalls” to help staff become more aware of residents’ needs.   For example, the module on falls includes a mnemonic checklist “HEAR ME” to help prevent falls in the facility:

  • Hazards in the environment.
  • Educate residents.
  • Anticipate residents’ needs.
  • Round frequently.
  • Materials and equipment.
  • Exercises and ambulation.

Module 1 notes that the elderly do not exhibit the same signs and symptoms of illness that are seen in younger persons.  Therefore, identification of subtle changes can alert staff to a serious illness.  The AHRQ notes the top 12 changes in residents are:

A.  Physical Changes: Walking; Urination and bowel patterns; Skin; Level of weakness; Falls; and Vital signs.

B.   Non- Physical Signs: Demeanor, Appetite, Sleeping, Speech, Confusion or agitation, complaints of pain.

Our Insight. Your Advantage.   Much of the material will not be new to many providers.  However, use of the training modules developed, and following the steps advocated, by the AHRQ will provide strong evidence that the provider’s care was within the standard of care.   Long term care facilities that incorporate the AHRQ’s training standards into their care will be ahead of the game in number of areas such as:

  1. Regulatory compliance;
  2. Limiting exposure to civil malpractice;
  3. Reimbursement matters.

The Department of Health and Human Services Office for Civil Rights (OCR) recently released the protocol it developed as a guideline for conducting the HIPAA privacy, security and breach notification audits mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act enacted in 2009. The OCR launched the audit program in 2011 and developed the protocol based on the first 20 audits completed under the program. Three of the initial audits were performed on group health plans, highlighting that employer-sponsored group health plans are subject to the Health Insurance Portability and Accountability Act (HIPAA) as covered entities and are subject to audit under the protocol. The audit program represents a significant shift in HIPAA enforcement from the largely reactive, complaint-based enforcement of the past to proactive compliance monitoring.

The pilot phase of the audit program began in November 2011 and is expected to include audits of 115 covered entities by December 2012. HITECH extended HIPAA compliance requirements to business associates and, therefore, business associates are expected to be included in the audit program following publication of the final HITECH regulations. The OCR indicated that funds have already been appropriated to carry out the audit program in 2013 and 2014.

In the wake of the U.S. Supreme Court’s June 28, 2012, decision upholding the constitutionality of the 2010 Patient Protection and Affordable Care Act, employers who had been awaiting the decision should now focus on compliance. We expect additional guidance will be released to implement several pending provisions, including those related to the 2014 employer…