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The Louisiana Supreme Court has, once again, affirmed the constitutionality of the statutory cap for damages in Medical Malpractice cases.  On March 13, 2012, the Court reiterated its prior holding that the cap is constitutional and applicable to all qualified healthcare providers under the Medical Malpractice Act, including nurse practitioners.  The statutory cap on damages…

The Louisiana Department of Health and Hospitals (“DHH”) has settled a class action lawsuit filed on behalf of Medicaid beneficiaries receiving Long Term Personal Care Services (“LT-PCS”). The class action is pending in the U.S. District Court, Middle District of Louisiana. The presiding federal judge has issued preliminary approval of the settlement. A final approval…

The Department of Health and Human Services, Office of Inspector General (“OIG”), recently issued an advisory opinion in which the OIG concluded that an arrangement between a primary care physician and an allergy testing and immunotherapy laboratory company (“Company”) could potentially generate prohibitive remuneration under the Federal Anti-Kickback Statute possibly resulting in administrative sanctions. Under…

CMS released 2011 recovery results for the Recovery Audit Contractor (RAC) Program. The 2011 figures reflect a significant increase over the amounts recovered or returned to providers in 2010. Through four quarters (October, 2010 through September, 2011), RAC contractors recovered a total of $797.4 million in overpayments, with $141.9 million in underpayments returned to providers.…

On November 16, 2011, Louisiana Department of Health and Hospitals’ (“DHH”) Secretary Bruce Greenstein announced that the Centers for Medicare and Medicaid Services (“CMS”) had approved an amendment to Louisiana’s Medicaid State Plan to implement the Coordinated Care Networks (“CCN”) also known as “Bayou Health.” The movement by DHH toward CCNs began in February, 2011, when DHH issued a Notice of Intent to provide for the implementation of the CCNs. On June 20, 2011, DHH issued the final rules for the CCNs. DHH has since awarded contracts to five private insurers who will administer the CCNs. The Coordinated Care Network Program Prepaid (“CCN-P”) contracts were awarded to:

  1. Louisiana Healthcare Connections, Inc.
  2. Amerihealth Mercy of Louisiana, Inc.
  3. AmeriGROUP Louisiana, Inc.

The Coordinated Care Network Program Shared Savings (“CCN-S”) contracts were awarded to:

  1. UnitedHealthcare of Louisiana, Inc.
  2. Community Health Solutions of America, Inc.

Continue Reading Louisiana Moves One Step Closer To Coordinated Care Networks For Medicaid Beneficiaries

In less than a month, the Louisiana Department of Health and Hospitals will begin enforcement of its new Home and Community-Based Service Providers Minimum Licensing Standards. The new regulations, which were published in the June 2011 Louisiana Register, contain one set of licensing standards that apply to providers of the following community-based services: Adult Day…

Since 2003, Louisiana, through the Department of Health and Hospitals (“DHH”) and the Medicaid Program, administers home and community-based health services (“HCBS”) available to disabled citizens. The HCBS includes several programs, one of which is the Long Term Personal Care Services (“LT-PCS”) program. The LT-PCS program provides disabled citizens with a personal care worker to assist with performing personal care or household chores that the disabled citizen would otherwise be unable to perform, in order to avoid being institutionalized. Individuals who do not qualify for LT-PCS or who seek additional or alternative services may enter one of Louisiana’s waiver programs: Elderly and Disabled Adults, Adult Day Health Care, Program of All-inclusive Care for the Elderly, or Money Follows the Person for individuals transitioning from nursing facilities. However, these programs have limited slots, geographical or age limits, and long waiting lists. An individual may be moved to the top of the priority list and immediately obtain a waiver, if the individual has had a hospital stay in excess of 30 days or has been treated in a nursing facility for 120 consecutive days.
Continue Reading Court Certifies Class Action and Finds Reduction in Medicaid LT-PCS Program Violates Americans with Disabilities Act

Act 337 of the Regular Session of the 2011 Louisiana Legislature enacted an amendment to Louisiana R.S. 37:1285(A) to add new subsection (A)(32), which provides an additional ground for physicians to be disciplined by the Louisiana State Board of Medical Examiners (the “LSBME”). The new ground relates to a physician holding herself/himself out to the…

On June 21, 2011, a Federal Grand Jury in Virginia filed an indictment against a physician for criminal violations of the Health Insurance Portability and Accountability Act (“HIPAA”). The indictment alleges three (3) counts of unauthorized disclosure of a patient’s individually identifiable health information to an agent of the patient’s employer. The indictment alleges that…