Free Health Law Webinar–Steps to Take When a Fraud, Waste, or Abuse Issue is Discovered

It’s your last chance to register for the first free webinar in Wolters Kluwer Legal & Regulatory, U.S.’s four-part webinar series in partnership with Alston & Bird focusing on best practices for handling internal and external healthcare fraud and False Claims Act investigations.

“Steps to Take When a Fraud, Waste, or Abuse Issue Is Discovered”, will cover the essential elements of a comprehensive investigation plan that prudent organizations should develop as a first step when fraud, waste, or abuse is discovered. To register, visit the link below:
Steps to Take When a Fraud, Waste or Abuse Issue is Discovered
Thursday, November 1, 2018 at 3 PM EST
Moderator: Frank Sheeder, Partner at Alston & Bird
Featured speakers: Jason Popp, Partner, and Brad Smyer, Senior Associate at Alston & Bird

For information on the full webinar series, visit http://health.wolterskluwerlb.com/2018/10/wk-announces-free-webinar-series-on-healthcare-investigations/

WK Announces Free Webinar Series on Healthcare Investigations

Wolters Kluwer Legal & Regulatory U.S. announced that registration is open for a four-part webinar series in partnership with Alston & Bird focusing on best practices for handling internal and external healthcare fraud and False Claims Act investigations. This educational activity has been submitted to HCCA and is currently pending their review for continuing education.

Each webinar in the series will feature Alston & Bird attorneys covering topics such as handling fraud, waste, and abuse issues, dealing with internal and government investigations, and managing complainants and whistleblowers. These discussions will be based on real-life scenarios that participants will receive in advance, and will offer practical, actionable approaches to the most confounding challenges. The webinars will also include a demonstration of how compliance professionals can leverage Cheetah™, Wolters Kluwer’s intuitive legal research platform, to assist in mitigating risks and issues.

“Healthcare industry stakeholders need to be aware of the potential legal and regulatory compliance risks, costs, and disruptions that can potentially arise in an organization,” said Kristen Kaplan, Sr. Health Law Product Manager for Wolters Kluwer Legal & Regulatory U.S. “This webinar series will offer practical and actionable approaches to mitigating these issues.”

“Healthcare organizations face a challenging legal, regulatory, and enforcement environment,” said Frank Sheeder, Partner at Alston & Bird and Co-Chair of its Healthcare Litigation Team.  “We are pleased to partner with Wolters Kluwer on this webinar series to share our experiences and help their in-house counsel, compliance professionals, and reimbursement teams to better serve their organizations.”

The first webinar in the series, “Steps to Take When a Fraud, Waste, or Abuse Issue Is Discovered”, will cover the essential elements of a comprehensive investigation plan that prudent organizations should develop as a first step when fraud, waste, or abuse is discovered. To register, visit the link below:
Steps to Take When a Fraud, Waste or Abuse Issue is Discovered
Thursday, November 1, 2018 at 3 PM EST
Moderator: Frank Sheeder, Partner at Alston & Bird
Featured speakers: Jason Popp, Partner, and Brad Smyer, Senior Associate at Alston & Bird

The second webinar, “Internal and Government Investigation Strategies”, will discuss how companies can conduct cohesive internal investigations, what the government expects organizations to do and the investigative techniques that the government uses. To register, visit the link below:
Internal and Government Investigation Strategies 
Tuesday, December 4, 2018 at 2 PM EST
Moderator: Frank Sheeder, Partner at Alston & Bird
Featured speakers: Wade Miller, Partner, and Matt Dowell, Senior Associate at Alston & Bird

The third webinar is titled “Dealing with the Government, Complainants, and Whistleblowers”. It will explore the external and internal adversaries organizations face and participants will hear from a former United States Attorney about best practices for contending with them. To register, visit the link below:
Dealing with the Government, Complainants, and Whistleblowers 
Thursday, January 10, 2019 at 2 PM EST
Moderator: Frank Sheeder, Partner at Alston & Bird
Featured speakers: Former US Attorney Thomas Walker and Meredith Kingsley, Partners at Alston & Bird

“Lessons Learned That We Hope Not to See Repeated” will discuss some of the most notorious investigation failures that have occurred in healthcare organizations, and the speakers will offer advice on how to avoid pitfalls. To register, visit the link below:
Lessons Learned that We Hope Not to See Repeated 
Wednesday, February 6, 2019 at 2 PM EST
Featured speakers: Frank Sheeder and Mitch Mitchelson, Partners at Alston & Bird

About Alston & Bird
Alston & Bird is a leading national and international law firm. The firm’s core practice areas are complex litigation, corporate, intellectual property and tax, with national industry practices that include healthcare, life sciences, financial services, technology, manufacturing, and energy. The firm has built a reputation as one of the country’s best employers, appearing on Fortune magazine’s “100 Best Companies to Work For” list for 19 consecutive years, an unprecedented accomplishment among law firms in the United States. The firm has offices in Atlanta, Beijing, Brussels, Charlotte, Dallas, Los Angeles, New York, Raleigh, San Francisco, Silicon Valley, and Washington, D.C.

For more information about Alston & Bird, visit www.alston.com, follow us on FacebookTwitter, and LinkedIn.

About Wolters Kluwer Legal & Regulatory U.S.
Wolters Kluwer Legal & Regulatory U.S. is part of Wolters Kluwer N.V. (AEX: WKL), a global leader in information, software solutions and services for professionals in the health, tax and accounting, risk and compliance, finance and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

Wolters Kluwer reported 2017 annual revenues of €4.4 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

For more information about Wolters Kluwer Legal & Regulatory U.S., visit www.WoltersKluwerLR.com, follow us on FacebookTwitter and LinkedIn.

Rural hospitals hit hard by reductions in Medicare disbursements, declining population

Approximately 3 percent of all rural hospitals closed in the period between 2013 and 2017, which can affect rural residents’ access to health care services. The U.S. Government Accountability Office (GAO) did a study to determine how HHS supports and monitors rural hospitals’ financial viability and rural residents’ access to hospital services. The study also details the number and characteristics of rural hospitals that have closed as well as what is known about the factors that contributed to those closures. According to the GAO report, Medicare Dependent Hospitals and for-profit hospitals were some of the hardest hit by reductions in Medicare disbursements, while hospitals in Medicaid expansion states and states with higher enrollment under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) were the least affected (GAO Report, GAO-18-634, September 30, 2018).

Rural hospitals

In 2017, 2,250 general acute care hospitals in the United States met the definition of rural. Rural hospitals represented approximately 48 percent of hospitals nationwide and 16 percent of inpatient beds. Rural hospitals spread across 84 percent of the United States land area that is classified as rural and served 18 percent of the United State population that lived in those areas. Rural areas tend to have a higher percentage of elderly residents than urban areas, a higher percentage of residents with limitations in activities caused by chronic conditions, and a lower median household income. Rural areas also face a decreasing population and slow employment growth.

Payment policies and programs

HHS provides key financial support to rural hospitals to provide rural residents access to hospital services through a number of payment policies and programs. CMS administers five rural hospital payment designations, in which rural or isolated hospitals that meet specified eligibility criteria receive higher reimbursement for hospital services than they otherwise would have received under Medicare’s standard payment methodology. The Federal Office of Rural Health Policy (FORHP) administers multiple grant programs, cooperative agreements, and contracts that provide funding and technical assistance to rural hospitals. CMS’s Center for Medicare and Medicaid Innovation tests new ways to deliver and pay for healthcare. There are also the broader HHS payment policies and programs such as Medicare and Medicaid base payments, Medicare and Medicaid uncompensated care payments, the state innovation models initiative, as well as other targeted HHS payment policy and programs.

Rural hospital closures

An analysis of data shows that from 2013 through 2017, 64 rural hospitals closed. This is more than twice the number of rural hospitals that closed during the prior 5-year period and accounts for more than the share of urban hospitals that closed and more than the number of rural hospitals that opened. Rural hospitals in the South represented 38 percent of the rural hospitals in 2013 but accounted for 77 percent of the rural hospital closures from 2013 through 2017. Medicare dependent hospitals represented 9 percent of the rural hospitals in 2013 but accounted for 25 percent of the rural hospital closures.

For-profit hospitals are twice as likely to experience financial distress relative to government-owned and non-profit hospitals and represented 11 percent of rural hospitals in 2013 but accounted for 36 percent of closures. Bed size also seems to be a factor as rural hospitals with between 26 and 49 inpatient beds represented 11 percent of the rural hospitals in 2013 but accounted for 23 percent of the closures. While critical access hospitals (CAHs), which have 25 acute inpatient beds or less and make up a majority of the rural hospitals, were less likely than other rural hospitals to close. This may be due, in part, to the CAH payment designation.

Contributing factors

Data shows that rural hospital closures were generally preceded and caused by financial distress. This is partially due to a decrease in patients seeking inpatient care at rural hospitals. There are an increasing number of federally qualified health centers or newer hospital systems outside of the area that create increased competition for rural hospitals. Technological advances have also allowed for more services to be provided in outpatient settings. There is also data showing that the years 2010 through 2016 marked the first recorded period of rural population decline.

Rural hospitals are sensitive to changes in Medicare payments because, on average, Medicare accounted for approximately 46 percent of their gross patient revenues in 2016. Reductions in nearly all Medicare reimbursements and reductions in Medicare bad debt payments have contributed to negative margins for rural hospitals.

Medicaid expansion

According to stakeholders that were interviewed and literature that was reviewed, the strongest factor that likely strengthened the financial viability of rural hospitals was the increased Medicaid eligibility and enrollment under the ACA. A 2018 study showed that Medicaid expansion was associated with improved hospital financial performance and a substantially lower likelihood of closure, especially in rural markets. Drops in uninsured rates in 2008 through 2009 and 2014 through 2015 corresponded with states’ decisions to expand Medicaid, with small towns and rural areas seeing the largest increase in Medicaid coverage and decline in uninsured. Data shows that from 2013 through 2017, rural hospitals in states that had expanded Medicaid as of April 2018 were less likely to close compared with rural hospitals in states that had not expanded Medicaid.

Hospitals pay nearly $1 million over ABC television documentary

After allegations that the privacy of patients was compromised by inviting film crews for an ABC television documentary series without first obtaining authorization, three hospitals in Boston have agreed to pay nearly $1 million to settle potential violations. The HHS Office for Civil Rights (OCR) has reached separate settlements with Massachusetts General Hospital (MGH), Brigham and Women’s Hospital (BWH), and Boston Medical Center (BMC) for compromising the privacy of patients’ protected health information (PHI) by inviting film crews for an ABC television network documentary series, without first obtaining authorization from patients. Collectively, the three entities paid OCR $999,000 to settle potential violations of the HIPAA Privacy Rule. HHS has also provided specific guidance about the Health Insurance Portability and Accountability Act (P.L. 104-191) and media coverage, including direction that blurring or pixilation is insufficient to protect patient privacy (Resolution Agreement, August 3, 2018; Resolution Agreement, September 6, 2018; Resolution Agreement, September 6, 2018).

Settlements 

To resolve potential HIPAA violations, MCH agreed to pay $515,000, BWH agreed to pay $384,000, and BMC agreed to pay $100,000. Each entity also agreed to provide workforce training as part of a corrective action plan that will include OCR’s guidance on disclosures to film and media. HHS initiated the investigation of BWH based on information in a Boston Globe newspaper article that indicated BWH permitted ABC News to film a medical documentary program at BWH. HHS also initiated of an investigation of MGH based on a news story posted to MGH’s website indicating that ABC News would be filming a medical documentary program at MCH.

This is the second HIPAA case involving an ABC medical documentary television series. In 2016, New York-Presbyterian Hospital entered into a settlement in association with the filming of “NY Med.” “Patients in hospitals expect to encounter doctors and nurses when getting treatment, not film crews recording them at their most private and vulnerable moments,” said Roger Severino, OCR director. “Hospitals must get authorization from patients before allowing strangers to have access to patients and their medical information.”

Guidance on media coverage

HHS reaffirmed that health care providers cannot invite or allow media personnel, including film crews, into treatment or other areas of their facilities where patients’ PHI will be accessible. This includes any written, electronic, oral, or other visual or audio form, or otherwise make PHI accessible to the media, without prior written authorization from each individual who is or will be in the area or whose PHI otherwise will be accessible to the media. It is not sufficient for a health care provider to request or require media personnel to mask the identities of patients. Using techniques such as blurring, pixelation, or voice alteration software for whom an authorization was not obtained is insufficient.

Only in very limited circumstances does the HIPAA Privacy Rule permit health care providers to disclose protected health information to members of the media without a prior authorization signed by the individual. For example, a covered entity may seek to have the media help identify or locate the family of an unidentified and incapacitated patient in its care. The HIPAA Privacy Rule does not require health care providers to prevent members of the media from entering areas of their facilities that are otherwise generally accessible to the public, which may include public waiting areas or areas where the public enters or exits the facility. A health care provider may also utilize the services of a contract film crew to produce training videos or public relations materials on the provider’s behalf if certain protections are in place.