Insight and Information on Louisiana Law, Litigation, and Legal Culture
On April 11, Kean Miller’s Merger & Acquisition team will present a business briefing In Through the Out Door: Preparing for Your Business Exit Opportunity. The program will be held from 3:15 – 6:00 PM at the Baton Rouge office of Kean Miller (II City Plaza, 400 Convention Street, 7th Floor, 70802).
The program…
On December 12, 2012, the U.S. Department of Health Human Services (HHS) launched a new website focused on the use of mobile devices in relation to health information privacy and security. The website is entitled Mobile Devices: Know the RISKS. Take the STEPS. PROTECT and SECURE Health Information. The website provides educational materials, such…
The Medicare laws have undergone significant changes. With the relatively new reporting regulations and the focus on compliance, litigators must implement new procedures in their practice. Many companies are establishing guidelines to obtain information needed to comply with the Medicare Secondary Payer Act (“MSP”) and the Medicare, Medicaid and SCHIP Extension Act of 2007 (“MMSEA”).…
The question of whether a Medicare Set Aside (MSA) is required in a Jones Act and/or personal injury case continues to be without a definitive answer. However, in Sippler v. Trans Am Trucking, Inc., 10-CV-03550, the United States District Court for the District of New Jersey ruled in an unpublished opinion that a MSA is not necessary in a personal injury matter.
To recap: the Medicare Secondary Payer Statute (MSP) assigns primary responsibility for medical bills of Medicare recipients to private health plans when a Medicare recipient is also covered by private insurance. These private plans are therefore considered primary under the MSP. Medicare acts as the secondary payer responsible only for paying amounts not covered by the primary plan. The MSP bars Medicare payments where a payment has already been made or can reasonably be expected to be made by a primary plan. (1)
Medicare payments are subject to reimbursement to the appropriate Medicare Trust Fund once the U.S. government receives notice that a third party payment has been or could be made with respect to the same item or service. If an MSP reimbursement is not made, the MSP authorizes the government to bring an action against any entity which is required or responsible to make payment under primary plan and against any other entity that has received payment from that entity. Note that “any entity” includes the parties to a lawsuit and their legal counsel.Continue Reading Recent Developments in Medicare Set Aside
Medicaid costs for Personal Care Services (“PCS”), designed to allow Medicaid beneficiaries to remain in their homes rather than being institutionalized, totaled approximately $12.7 billion in 2011, representing a 35% increase in spending since 2005. The cost for PCS is projected to grow by approximately 45% by the year 2018, certainly making PCS an area of interest to the federal government. PCS providers should expect to see increased federal oversight and control over these programs.
The Office of Inspector General (“OIG”) published a report in November, 2012 based on its examination of PCS and its findings of significant compliance, payment, and fraud vulnerabilities. The OIG also interviewed Medicaid beneficiaries receiving PCS services and found quality of care problems with PCS attendants, including physical abuse or threats of abuse, property theft, and beneficiary abandonment.
As of August, 2012, the OIG has produced 23 audit and evaluation reports focusing on PCS providers and programs in various states, including one in Louisiana. The Louisiana Department of Health and Hospitals, which oversees PCS programs, concurred with the findings and recommendations in the OIG audit. The OIG’s Office of Investigations and State Medicaid Fraud Control Units also reported an increasing volume of fraud involving PCS. The most commonly reported fraud schemes involved conspiracies between PCS attendants and Medicaid beneficiaries regarding claims for services that were never provided or that were not allowed under the States’ program rules.Continue Reading OIG Report on Personal Care Services: Trends, Vulnerabilities, and Recommendations for Improvement
The Centers for Medicare and Medicaid Services (“CMS”) has added a new face-to-face encounter requirement related to the ordering of certain Durable Medical Equipment (“DME”) items in the Medicare Program Revisions to Payment Policies under the Physician Fee Schedule Final Rule that was published in November, 2012 (the “Final Rule”). For covered DME items requiring a written order, physicians must document that a face-to-face encounter with the beneficiary occurred within six (6) months before the written order. The new rule is effective for all covered DME items ordered on or after July 1, 2013. The rule does not apply retrospectively to DME orders prior to July 1, 2013. CMS is not implementing a requirement for a face-to-face encounter for prosthetic devices, orthotics, and prosthetics that require a written order, at this time, and deferred to future rule-making to address this area.
Continue Reading CMS Imposes New Requirements on Health Care Providers for Face-to-Face Encounters for DME Orders
We’ve all been there. You sit on the Board of a local non-profit organization as the token lawyer. Or, you volunteered to assist with your house of worship’s finance committee because you have some practice experience with banks. Inevitably the scenario comes up: “You’re a lawyer. Will you help us buy that little piece of…
Employers find themselves in uncharted territory when it comes to responding to social media activity by their employees, particularly in the wake of a series of reports issued by the National Labor Relations Board’s acting general counsel. But on September 28, 2012, in the Board’s first decision involving a discharge for Facebook postings, the NLRB…
On August 29, 2012, the Securities and Exchange Commission (the “SEC”) proposed rules to eliminate the prohibition against general solicitation and advertising in certain unregistered securities offerings. These rules are mandated by the Jumpstart Our Business Startups Act (the “JOBS Act”), which was signed into law on April 5, 2012, and is intended to, among…
On August 22, 2012, the Securities and Exchange Commission (the “SEC”) adopted rules (the “Conflict Minerals Rules”) to implement provisions of the Dodd-Frank Wall Street Reform and Consumer Protection Act to require certain companies to publicly disclose their use of conflict minerals (gold, tantalum, tin and tungsten) that originated in the Democratic Republic of the Congo or any of its adjoining countries, collectively referred to as the “covered countries.” (1) These new rules impose additional disclosure obligations on affected companies that use conflict minerals in their products.
The Conflict Minerals Rules apply to a company if it files annual reports with the SEC under the Securities Exchange Act of 1934 (a “Registrant”) and if conflict minerals are “necessary to the functionality or production” of a product manufactured or contracted to be manufactured by the Registrant. If required, a Registrant will file a conflict minerals report on the SEC’s new Form SD (specialized disclosure) by May 31, 2014 (for the 2013 calendar year) and annually on May 31 every year thereafter.
The Conflict Minerals Rules require that all Registrants undertake a three-step analysis to determine whether disclosure is required, and to what extent. Below is a summary for general information regarding the principal requirements of the Conflict Minerals Rules.
Continue Reading SEC Adopts Rules for Disclosing Use of Conflict Minerals
