IRS Announcement 2011-20 grants certain tax-exempt organizations a three-month extension for filing Form 990. The extension applies only to organizations that operate one or more hospital facilities and are required to file Schedule H with the 2010 Form 990.
These hospitals would otherwise be required to file the 2010 Form 990 before August 15, 2011. The hospitals now have an automatic three-month extension, and the announcement also directs these hospital organizations not to file the 2010 Form 990 before July 1, 2011. The delay allows the IRS to complete changes to IRS forms and systems that are required by Section 9007 of Patient Protection and Affordable Care Act.
For additional information and to view the announcement, click here.
Federal authorities continue to move forward with unprecedented enforcement of HIPAA violations. Massachusetts General Hospital entered into a $1 million settlement, plus corrective actions, in response to an employee’s loss of scheduling documents that included information on patients with HIV/AIDS. The employee reportedly left the documents on a subway train. For more information, click here.
The U.S. Citizenship and Immigration Services (USCIS) has issued an updated “Handbook for Employers: Instructions for Completing Form I-9.” The handbook provides guidance in completing the Form I-9 and answers 64 frequently-asked questions. It includes examples of new USCIS documents. The revised handbook is available online at http://www.uscis.gov/files/forms/m-274.pdf.
The U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) has issued a Notice of Final Determination finding that Cignet Health of Prince George’s County, Md., (Cignet) violated the Privacy Rule of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA). HHS imposed a civil money penalty (CMP) of $4.3 million for the violations — the first CMP issued for a covered entity’s violations of the HIPAA Privacy Rule.
For more information or to read the entire article, visit the Morningstar.com web link.
The Medicare Fraud Strike Force indicted 111 defendants for their alleged participation in Medicare fraud schemes totaling more than $225 million in false billing. The announcement came from the Department of Justice (DOJ) and Department of Health & Human Services (HHS) after charges were filed against the defendant physicians, nurses, health care company owners, and executives, for a variety of crimes including conspiracy to defraud the Medicare program, criminal false claims, anti-kickback statute violations, money laundering, and aggravated identity theft.
According to the joint DOJ and HHS press release, the defendants participated in schemes to submit claims for medically unnecessary treatments or treatments that were never provided. In exchange for kickbacks, the defendants also allegedly provided beneficiary information to providers who submitted fraudulent billing to Medicare. The February 17 operation is “the largest-ever federal health care fraud takedown,” according to the DOJ/HHS. The defendants are located across the country, including cities in Florida, Michigan, New York, Texas, California, Louisiana, Illinois, and Texas.
In addition to the charges, the DOJ and HHS announced an expansion of the Strike Force to Chicago and Dallas. The Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators. The Strike Force is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT) charged with preventing and deterring fraud and enforcing current anti-fraud laws. Since their 2007 inception, Strike Force teams have charged more than 990 people for false Medicare billing practices totaling more than $2.3 billion.
If passed, the Strengthening Medicare Anti-Fraud Measures Act, introduced on February 11 by Representatives Wally Herger (R-CA) and Pete Stark (D-CA), would expand the OIG’s exclusion authority to address gaps in fraud legislation. The legislation would expand OIG’s permissive exclusion authority to individuals and entities affiliated with sanctioned entities. According to the Representatives’ press release, the proposed legislation closes two important loopholes:
1. Under current law, executives who have left the company by the time of conviction cannot be barred from federal health care programs. Under the proposed legislation, corporate executives may be banned from doing business with Medicare if their companies are convicted of fraud even after they leave the company.
2. Under the legislation, parent companies engaging in fraud through shell companies are no longer insulated from liability and may be excluded from participation in federal health care programs.
Representatives Herger and Stark, the Chairman and Ranking Member of the House Ways and Means Health Subcommittee, are joined by nineteen other Representatives in sponsoring the bill. The legislation was introduced and passed in the House last year, but the Senate failed to pass it.
For the text of the bill, visit: http://go.usa.gov/gcH
Because the Centers for Medicare and Medicaid Services (CMS) has not yet published final regulations on telemedicine, it has allowed The Joint Commission (TJC) to delay changes to its telemedicine standards until July 1, 2011. The TJC’s current telemedicine standards are in conflict with the Medicare Conditions of Participation, which do not allow for credentialing by proxy. The proposed rule issued by CMS last year would permit credentialing by proxy between CMS-accredited hospitals.
TJC issued the following statement:
The Centers for Medicare & Medicaid Services (CMS) has not yet published its new telehealth regulations, which it had expected to do by March 1, 2011. Therefore, CMS has now notified The Joint Commission that it has an extension to July 1, 2011 before The Joint Commission will need to alter its telehealth standards to comply with CMS telehealth regulations. Our hope is that the new regulation will modify existing CMS standards in this area to be more in keeping with Joint Commission requirements. CMS expects to publish its telehealth regulations shortly and when it does, The Joint Commission will make changes to its standards in accordance with the regulation and will notify its accredited hospitals and critical access hospitals of the timeframe expected for implementation of the new CMS regulations.
As background on this issue, since September 2009, The Joint Commission has engaged CMS and members of Congress regarding the issue of credentialing and privileging by proxy as it relates to telemedicine providers and users. The Joint Commission took the position that there would be an adverse affect on the access to some telehealth services if organizations were not allowed to comply with Joint Commission requirements addressing credentialing and privileging by proxy. The Joint Commission’s position has been that the CMS requirements place an undue burden on many organizations without improving the quality of services, provider accountability and the effectiveness of the credentialing and privileging processes.
If you were involved with a kyphoplasty audit, this may sound familiar. A number of hospitals and health systems have recently been served with subpoenas by the United States Department of Justice regarding Medicare billing for implantable cardioverter defibrillators (“ICDs”). The DOJ is investigating whether hospitals billed Medicare for ICDs for patients who did not satisfy coverage National Coverage Determination criteria. For example, NCD criteria provides that Medicare does not cover implantation of ICDs in patients who lack a history of arrhythmia, even if their heart function indicates that they are at an elevated risk of sudden death due to arrhythmia, if the implantation occurred within 40 days of an acute myocardial infraction or within three months of a bypass surgery or angioplasty. The DOJ also is investigating the three largest ICD manufacturers regarding their communication with providers regarding Medicare billing – much like the DOJ’s past investigation of Kyphon as part of their kyphoplasty investigation.
The National Coverage Determination criteria can be found in the NCD Manual Section 20.4. If you have any questions about your ICD billing practices, please contact our Compliance Team.
Does your hospital currently credential advance practice registered nurses (APN) and physician assistants (PA) through your human resources department?
New Joint Commission standards will change the credentialing and privileging process for certain advance practice registered nurses (APN) and physician assistants (PA).
Previous Joint Commission standards afforded APNs and PAs equivalent credentialing and privileging processing through the HR department. However, The Centers for Medicare & Medicaid Services (CMS) does not recognize the equivalent process, and The Joint Commission must align its standards to be consistent with CMS. Under the new clarification guidelines, certain APNs and PAs must now be processed through the medical staff office, not HR.
According to the new Joint Commission Standards BoosterPak™, released in January.The Joint Commission states the following:
Those who provide “medical level of care” must use the medical staff process for credentialing and privileging, making all [medical staff] standards applicable (including recommendation by the organized medical staff and approval by the governing body, OPPE, and FPPE).
- APNs should request privileges only for those responsibilities involving medical level of care and not those responsibilities already allowed under the RN scope of practice.
- APNs and PAs who provide “medical level of care” must be credentialed and privileged through the medical staff standards process
- APNs and PAs who do not provide “medical level of care” utilize the human resources “equivalent” process detained in HR.01.02.05, EPs 10–15.
The Joint Commission has not yet provided an implementation date for these changes.
The BoosterPak is available to accredited organizations on the Joint Commission Connect extranet.
The Centers for Medicare and Medicaid Services revised its Hospital Conditions of Participation this past summer to permit a qualified and licensed practitioner who is responsible for the care of the patient to order respiratory care, provided the practitioner is acting within his/her scope of practice under state law. See 42 CFR 482.57(3). The hospital’s medical staff must also authorize the practitioner to order respiratory care services. See id. Because of this revision, Medicare now allows nurse practitioners, physician assistants and others to order respiratory care without a physician’s countersignature if state law permits such practitioners to issue respiratory care orders.
Until January 28, 2011, however, Wisconsin law still required that a physician order all respiratory care services. See Wis. Admin. Code DHS §124.22(4). The physician may then delegate the task of ordering respiratory services to mid-levels, who then write the orders for the respiratory care, as long as a physician counter-signs the order. See http://www.dhs.wisconsin.gov/rl_DSL/Hospital/frequentAskQs.pdf (question 30). The DQA changed this discrepancy through the issuance of DQA Memo 11-004/Respiratory Therapy Orders in Hospitals, a statewide variance for DHS 124.22(4) to allow licensed practitioners, who are authorized via their practice act and are granted privileges by the medical staff of the hospital, to order respiratory care services. Effective immediately, this variance provides more flexibility for providers when it comes to respiratory care and can be found at http://www.dhs.wisconsin.gov/rl_dsl/Publications/11-004.htm.
