The Daily Scan

August 6, 2018

Last Updated: 8:50 AM EST 

Litigation 

  • South Carolina's largest provider of behavioral therapy for children with Autism, Early Autism Project (EAP), has paid the United Stated $8.8 million to settle allegations of fraud. The settlement announced resolves allegations that EAP billed TRICARE and South Carolina’s Medicaid program for ABA therapy services for children with autism that either misrepresented the services provided or where the services were not provided at all. Barbara Bowens, Acting United States Attorney for this case and Civil Chief for the United States Attorney’s Office for the District of South Carolina commented, “Companies that commit to providing intensive behavioral treatment to children with autism, at a pivotal time of that child’s development, should be held accountable if they do not provide the services, but nevertheless request payment for those services, The United States Attorney’s Office is committed to protecting the federally-funded programs that make it possible for children with special needs to receive these vital services.” (Justice.gov

  • Prime Healthcare Services Inc., Prime Healthcare Foundation, Inc., and Prime Healthcare Management, Inc., and the founder have all agreed to pay the United States $65 million to settle allegations that 14 Prime hospitals in California knowingly submitted false claims to Medicare. These claims were generated by the company admitting patients who required only less costly, outpatient care and by billing for more expensive patient diagnoses than the patients had. Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division commented, “This settlement reflects our ongoing commitment to ensure that health care providers appropriately bill Medicare, charging the government for higher cost inpatient services that patients do not need, and for higher-paying diagnoses than the patients have, wastes the country’s valuable health care resources." (Justice.gov

  • A New Jersey state appeals court reinstated Meadowlands Hospital Medical Center’s $26.3 million lawsuit to recoup unpaid or underpaid Medicaid and Medicare service payouts from insurance companies, ruling that more findings were needed to determine whether or not a lawsuit is the hospital’s last resort for relief. After the matter was removed to federal court and remanded to state court following a Third Circuit appeal, defendants moved to dismiss plaintiff's complaint pursuant to Rule 4:6-2(e) for failure to state a claim upon which relief can be granted. The Law Division granted defendants' motion, dismissing plaintiff's complaint with prejudice. (NJCourts.gov

Durable Medical Equipment 

  • In the Court of Appeals of Indiana, there was a dismissal of a suit against the medical device maker Stryker Corporation over privacy concerns from Stryker employees' observation of a knee operation. Facts from the case include the following statement, "in February of 2014, Dotson went to Woodlawn for knee-replacement surgery, which was to be performed by Dr. Sheedy. Shortly before she went under anesthesia, Dotson observed Bolinger and Reagan in her operating room with Dr. Sheedy and other Woodlawn medical personnel. Dotson could tell from their dress that Bolinger and Reagan were not medical personnel—they were in fact employees of Stryker, and they were present in the room ostensibly to discuss Stryker products with Dr. Sheedy as they related to knee replacements. Their presence in the operating room made Dotson uncomfortable, but before she could object she went under anesthesia." The Court of Appeals of Indiana affirmed the dismissal of Kathy Dotson’s suit from the Fulton Circuit Court. (IN.gov)

Regulation

  • During an OIG review, it was found that Illinois did not comply with federal wavier and state requirements at 18 of 20 adult day service centers. This program serves vulnerable adults who receive services and funding through the Elderly Waiver. The OIG found 105 instances of noncompliance with health and safety and administrative requirements. It was concluded that most instances of noncompliance occurred because center personnel did not have sufficient training on State requirements. (OIG.HHS.gov

  • The Federal Communication Commission voted last week to explore the creation of an experimental “Connected Care Pilot Program” to support the delivery of advanced telehealth services to low-income Americans. Through last week's Notice of Inquiry (NOI), the Commission seeks comment on creating a Universal Service Fund pilot program to promote the use of broadband-enabled telehealth services among low-income families and veterans, with a focus on services delivered directly to patients beyond the doors of brick-and-mortar health care facilities. The FCC commented in a press release, "The Commission’s top priority is bridging the digital divide, and nowhere is that more critical than in the area of health care. Today, whether it’s through remote patient monitoring or mobile health applications accessed via smartphones, tablets, or other devices, advances in broadband-enabled telehealth technologies are allowing patients to receive care wherever they are." (FCC.gov

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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