The Office of Inspector General (“OIG”) recently determined that Louisiana’s Medical Assistance Programs Integrity Law (“MAPIL”) does not meet certain requirements outlined in Section 6031 of the Deficit Reduction Act of 2005 (“DRA”). Section 6031 of the DRA provides a financial incentive to states who enact laws that establish liability to the state for individuals and entities that submit false or fraudulent claims to the state Medicaid program, if the state’s law satisfies certain requirements outlined in the DRA. If the Office of Inspector General (“OIG”) determines that a state false claims act meets the enumerated criteria under the DRA, then the state will receive a 10-percent increase in its share of Medicaid fraud recoveries from state actions brought under the state act. To date, the OIG has reviewed laws enacted in 10 states and determined that seven states’ laws, including MAPIL, do not comply with the DRA requirements.
Continue Reading OIG Reviews 10 State False Claims Acts, Louisiana Act Falls Short

The Louisiana First Circuit Court of Appeal ruled on December 28, 2006 that a CRNA may not rely on a “statement” issued by the Louisiana Board of Nursing that a CRNA may perform pain management procedures even if under the direction and supervision of a physician. A CRNA had asked the Louisiana State Board of Nursing for its opinion on whether a CRNA could perform pain management procedures. The Louisiana State Board of Nursing issued a “statement” which provided that the CRNA could perform procedures such as peripheral nerve blocks, epidural injections and injection of local anesthestics, if under the direction and supervision of the physician.
Continue Reading Court Concludes the Louisiana State Board of Nursing Improperly Released a “Rule” Affecting the Scope of Practice of CRNAs

On November 3, 2006, the United States Court of Appeals for the Eleventh Circuit, in the case of Gulfcoast Medical Supply v. Secretary, Department of Health and Human Services, issued an opinion that a certificate of medical necessity (“CMN”) does not unequivocally establish that durable medical equipment (“DME”) meets the reimbursement test of “reasonable and necessary”, as required by Medicare Part B. In the first case of its kind in any federal court of appeals, the Eleventh Circuit held that the Secretary of the Department of Health and Human Services (“DHHS”) may require a DME supplier to submit additional evidence beyond the CMN in order to establish the medical necessity of the item for reimbursement.
Continue Reading Certificate of Medical Necessity (CMN) May Not Be Enough To Prove Item “Reasonable and Necessary”

In the Louisiana Legislature’s Regular Session 2006, Act 323 changed La.R.S. 40:1299.47 to add Subsection N [full cite- 40:1299.47(N)] to allow for an expedited medical review panel process. The following discussion highlights some interesting changes, but for all elements of the new law as to the expedited medical review panel process, see the entire statute:
Continue Reading Act 323 – Expedited Medical Review Panel Process

The Department of Health and Human Services (“DHHS”) Office of Inspector General (“OIG”) and the Centers for Medicare and Medicaid Services (“CMS”) recently released on August 8, 2006 final rules establishing new safe harbors and exceptions for the donation of items and services for e-prescribing and electronic health records to physicians and other providers. These safe harbors and exceptions establish certain conditions under which: (1) health care providers furnishing services that are subject to the Stark Law (e.g., hospitals) may donate to physicians (and certain other recipients) certain qualifying electronic prescribing technology that are necessary and used solely for electronic prescribing; and (2) hospitals and other providers may provide physicians and other providers who furnish services to federal healthcare program recipients with interoperable electronic health records software or information technology and training services.
Continue Reading The OIG and CMS Establish New Safe Harbors and Exceptions to Foster Electronic Prescribing and Electronic Health Records Arrangements

In a three-two decision released today, the Third Circuit has ruled that the $500,000 cap on medical malpractice damages is unconstitutional as failing to provide an “adequate remedy” for plaintiffs as guaranteed under the provisions of La. Const. Art. 1, sec.22.

The opinion was written by Judge Elizabeth A. Pickett, with Judges Billy Ezell concurring…

On August 1, 2006, the United States Court of Appeals for the Sixth Circuit affirmed a decision of the Departmental Appeals Board (“DAB”) of the United States Department of Health & Human Services (“DHHS”) that had upheld an award of civil monetary penalties of $77,100.00 against a skilled nursing facility (“SNF”) in Ohio. The penalties came as a result of the facility being cited by the state survey agency for numerous violations the agency was unwilling to waive, despite finding that prior Medicare program-participant violations had been substantially corrected upon revisit surveys.
Continue Reading Federal Court of Appeals Upholds Civil Monetary Penalty Award Against SNF Despite Claim No Harm Was Sustained by Nursing Facility Residents

On August 18, 2006, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule that revises the hospital in-patient prospective payment systems (“PPS”) for fiscal year 2007. This article addresses the revisions CMS made to the requirements for Reporting Hospital Quality Data for Annual Payment Update (“RHQDAPU”) program in the PPS update. The revisions supplement the ten (10) quality measures CMS had established in November 1, 2003. These ten (10) quality measures involved Heart Attack, Heart Failure, and Pneumonia. For fiscal years 2005 and 2006, hospitals that chose not to submit quality data on the ten (10) quality measures received a 0.4 percentage reduction in payment update. For 2007 and subsequent years, the failure to report on the quality measures, which are being changed from 10 to 21 measures, will result in a 2.0 percent decrease. This large increase in reduction is mandated by the Deficit Reduction Act of 2005 (the “DRA”).
Continue Reading CMS Issues Final PPS Rule for In-Patient Hospital Services for Fiscal Year 2007