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Articles 1 result
Articles
09.10.2012
Navigating Hospital Provider-Based Billing
(Reprinted with permission from the September 10, 2012, edition of New Jersey Law Journal. © 2012 ALM Media Properties, LLC. All rights reserved. Further duplication without permission is prohibited.) By: Lisa Albright
Client Advisories 6 results
Client Advisories
06.26.2024
Do Your Monthly Checks to Avoid Fines and Risk of Exclusion from Federal Health Care Programs
Healthcare facilities are urged to remember to perform regular checks of both state and federal lists of excluded individuals and entities – i.e. persons or organizations who are prohibited from participating in federal and state health care programs – to ensure that their employees, independent contractors and vendors are not on such lists. As a general rule, federal health care programs such as Medicare will not pay for items or services which are furnished, ordered, prescribed, or supplied, whether directly or indirectly, by an individual or entity (i.e. a “Person”) who has been excluded from participation in that federal health care program. If a healthcare entity employs or engages an excluded Person and then bills a federal health care program for any items or services the excluded Person directly or indirectly furnished, ordered, or prescribed, it may also be subject to Civil Monetary Penalties (“CMP”) liability under the False Claims Act (“FCA”). It is important to note that the prohibition on services is broadly defined so as to include not only direct care, but also indirect services such as filling prescriptions, providing transportation services, and performing administrative and management services that are not separately billable. While OIG guidance does permit entities to employ/engage an excluded Person who does not provide any items or services paid for, directly or indirectly, by federal health care programs, doing so requires significant caution and a strict curtailing of their roles and responsibilities to ensure protection from future liabilities. While the regulations concerning exclusions have existed for almost fifty years, it is clear that they remain an important area of enforcement. Since 2023, the federal Office of Inspector General has issued over $2.5 million in CMPs to healthcare entities who have employed an excluded individual.In addition to the federal requirements surrounding excluded individuals, many states have not only adopted versions of the federal exclusion requirements, but have created their own exclusion criteria and penalties associated with employing an excluded individual. For this reason, participating providers should consult not only the federal guidance on exclusion checks, but also their state requirements. Best Practices to Ensure Compliance The responsibility of remaining compliant with state and federal exclusion provisions falls to the billing healthcare provider/ facility. The easiest method to ensure compliance is to maintain a robust compliance program within the entity through the development of policies and procedures that mandate routine checks of all employees and vendors against state and federal exclusion lists. Entities should also maintain records of these completed checks. Because the applicable lists are generally updated every thirty (30) days, it is recommended that entities perform checks upon engagement or employment, as well as every thirty (30) days thereafter. For healthcare providers in New Jersey, we recommend a monthly review of the following databases:
Client Advisories
07.26.2023
NJ DOH to Revoke Seven COVID-19 State of Emergency Health Care Facility Waivers
Most recently, as per its website, the NJ DOH will revoke seven health facility waivers as of August 13, 2023. They are:
Client Advisories
06.21.2021
Be Careful What You Contract For: HIPAA and Successor Liability
Successor liability arises when the purchaser is held responsible for the liabilities of the seller. Generally, asset purchases carry less risk of successor liability than ownership interest purchases or mergers. And sometimes, the liability of a seller can trigger an examination into the actions of the purchaser.
Press Releases 2 results
Press Releases
10.02.2014
Archer has promoted six attorneys to Partner, firm President Christopher R. Gibson and Chairman James H. Carll announced: Lisa Stewart Albright, Kimberly Anne Capadona, Michael F. Floyd, Alex Paul Genato, Michael S. Horn and Daniel C. Ritson.
Press Releases
12.10.2010
Lisa S. Albright Joins Health Care Law Practice Group
Attorney Lisa S. Albright has joined Archer, P.C., as an Associate in the Corporate Law Department in the firm’s Princeton, N.J., office, where she will concentrate on health care transactional and regulatory law.
Speaking Engagements & Seminars 3 results
Speaking Engagements & Seminars
07.15.2021
When: Thursday, July 15, 2021 10:00am – 10:30am
Speaking Engagements & Seminars
04.24.2020
Fran McElhill and Lisa Albright to speak at New Jersey Hospital Association's Webinar
When: April 24, 2015 1:00pm.
Speaking Engagements & Seminars
05.18.2015
Compliance Issues for Hospital Trustees
Who: Lisa Stewart Albright, Partner, Archer, P.C. Frances A. McElhill, Partner, Archer , P.C.