Healthcare Compliance Reminders: Recent Cases

Maintaining a balance of compliance, business and healthcare services continues to evolve.

Many of you became physicians to help those afflicted by disease. Many of you started a medical business to expand your ability to reach the public, but few of you realized that in doing so, there would be such a vast amount of rules (both state and federal) that would control how you created and expanded your medical business. The following is a quick summary of recent cases, settlements, and judgments that could serve as a warning to all of us regarding how easy it can be to step over some of the lines and to have internal policies, audits and controls to avoid even the appearance of impropriety.

1) Telemedicine fraud and kickback scheme. Recent reports made public an indictment of a telemedicine company that may have engaged in a pattern of kickbacks and submitting reimbursement requests for medically unnecessary orthotics. if the indictment is correct, then this business may have illegally benefited from up to $56 Million. Whether the indictment is true or false, this is a telling reminder for all of us to ensure that prescriptions are supported with proper medical records and that we all review the billing practices and marketing activities of not only ourselves but also any of our contract vendors. In the very least, consider some of the contractual protections available to you as a provider or a medical group.

2) Hospital Liens. When medical bills go unpaid, certain states have laws regarding how, when and through what mechanism a lien may be placed on the obligated party. In a recent case decided by the Court of Appeals in Colorado (Harvey v. Centura Health Corp., No. 19CA0091 (Colo. Ct. App. Jan. 30, 2020), the Court held that "[r]equiring [the hospital] to bill Medicare before creating a lien—when Medicare is still considered a secondary payer—erodes the purpose of the hospital lien statute to protect hospitals 'against financial losses resulting from personal injury cases.'"

3) Stark Violations Outside Medicare/Medicaid. Many providers and legal counsel incorrectly assume that Stark laws only apply to those reimbursements and payments related to Medicare/Medicaid. However, several states have enacted laws that would similarly subject other insurance payers to the same federal statute protections and compliance rules of Stark and Anti-Kickback. Double check your state laws. make sure that your referral patterns avoid violating the federal reimbursement rules or that such patterns fall within an outlined exception.

These are complicated areas. Don’t hesitate to reach out with questions or concerns.