Firm Client Tops Nation in Medicare Savings

Broad and Cassel client, Palm Beach Accountable Care Organization, tops the nation in Medicare savings, as detailed in the article below from the Palm Beach Post: 

A doctor group based in Palm Beach County leads the country in saving taxpayers money while meeting goals for keeping Medicare patients happy and healthy.

Palm Beach Accountable Care Organization based in Palm Springs saved taxpayers $62 million and was allowed to keep $30 million of that for 2016 because it earned high scores for patient health and satisfaction, according to federal officials. The group ranked No. 2 nationally in shared savings a year ago.

“We’re keeping our patients healthier and out of the hospital,” said board chairman Richard Weisberg. “The savings are good and we’re proud of those. Keeping patients healthy is most important.”

The group of 275 primary-care doctors and 175 specialists serves 69,000 Medicare patients from St. Lucie County to Miami-Dade County.

Please visit this page to continue reading. 

 

Posted in ACO | Tagged , , , , , , , , , , , , , ,

Predictive Analytics: New Frontiers in Hospital Pharmaceutical Inventory Management

The following article, written by Paul R. DeMuro, Ph.D. and Richard M. Klass, was published by South Florida Hospital News and Healthcare Report.

It’s 3:00 a.m. The administrator on duty gets a frantic call from the pharmacy. “We ran out of cytarabine! This means no treatment for our existing leukemia patients and turning away ten newly diagnosed with appointments tomorrow! My doctors are screaming at me!

Panic sets in. The administrator thinks: “What if we can’t get other hospitals to lend us a supply? Do I dare access the ‘gray market’? Can we compound the drug ourselves?”

A good inventory control model can reduce such frenzied situations and:

• Minimize total inventory costs, including holding (interest rate) and order placement expenses.
• Support just in time inventory levels – having supplies when you need them and stocking nothing else saves cash outlays, and optimizes storage space. Remember, over-stocking is just as bad as under-stocking.
• Ameliorate out-of-stock situations of the most critical drugs, particularly those with no substitute alternative.
• Minimize expired pharmaceutical waste. “U.S. hospitals and long-term care facilities annually flush approximately 250 million pounds of unused pharmaceuticals down the drain.” Mismanaged expiration dates is a big cost driver.

To continue reading, please click here.

Posted in Paul DeMuro, Technology | Tagged , , , , , ,

Assistance with Rules Requiring Emergency Power

Emergency rules requiring emergency power sufficient to maintain an ambient temperature of 80 degrees Fahrenheit or below for 96 hours in nursing homes and assisted living facilities have just been announced. All nursing homes and assisted living facilities MUST submit an emergency management plan by October 31, 2017, and fully comply by November 15, 2017, unless a variance is obtained.

A link to the emergency rule for nursing homes can be found here.

A link to the emergency rule for assisted living facilities can be found here.

What if your facility cannot timely comply?

Many nursing homes and assisted living facilities will not be able to comply with the emergency rule deadlines. If your facility cannot timely comply with the emergency rule or has questions, we can help.

Broad and Cassel LLP represents two major provider associations in connection with the emergency rulesWe can assist your facility with:

  • Variance Petition: If you are unable to implement the applicable emergency rule’s requirements by November 15, 2017, we can petition the appropriate agency on your behalf and request additional time to comply with the emergency rule.
  • Notifications of Compliance: If you are already in compliance or able to get into compliance by November 15, 2017, we can prepare and submit a notification of compliance on behalf of your facility.

For preparation of the variance or notification of compliance, our rates are $1,500 for engagements entered into prior to October 13th and $2,500 for all engagements entered between October 13th and 24th. All other legal services will be charged at the blended hourly rate of $250.00 per hour. Due to the large number of variances and notifications of compliance we anticipate preparing, Broad and Cassel will not give priority to emergency rule petition engagements after October 24, 2017.

Please visit this link for a client information package. 

For more information, contact Jay Adams, Esq. at 850-681-6810 or via email at jadams@broadandcassel.com.

Posted in Care Delivery, Compliance, David Miller, Douglas Mannheimer, Frank Rainer, Jay Adams, John Loar, Joshua Brian, Leonard Collins, Uncategorized | Tagged , , , , , , , , , , ,

Jamie Gelfman Joins Broad and Cassel’s Health Law Team

FORT LAUDERDALE (Sept. 28, 2017) – Statewide law firm Broad and Cassel LLP today announced the addition of Associate Jamie Gelfman to the firm’s Health Law Practice Group in the Fort Lauderdale office.

Prior to joining Broad and Cassel, Gelfman was an associate at Panza, Maurer & Maynard, P.A. where she primarily practiced in the arenas of administrative and regulatory law. While there, she advised clients on health care compliance issues; aided in the investigation, mitigation and reporting of HIPAA breaches; assisted with reimbursement issues and licensure issues with AHCA; and prepared HIPAA Privacy and Security Policies, Notices of Privacy Practices, HIPAA Authorizations for Use and Disclosure, Business Associate Agreements, and Informed Consents. To continue reading, please click here.

Posted in Practice News | Tagged , ,

Retired CEO Howard Root to Headline Broad and Cassel Health Forum Oct. 11

FORT LAUDERDALE, Fla. (Aug. 24, 2017) — Broad and Cassel’s Health Law Practice Group will once again host national and local experts for discussions around today’s rapidly changing health care landscape at the annual Broad and Cassel Health Forum Oct. 11.

New to the speaker lineup this year is retired CEO Howard Root, who after a five-year ordeal with the U.S. Department of Justice, authored Cardiac Arrest: Five Heart-Stopping Years as a CEO On the Feds’ Hit-List. A corporate lawyer by trade, he founded Vascular Solutions in 1997, and during his tenure, invented and launched more than 100 cardiovascular devices. Root will share his legal nightmare of how he fought Federal criminal charges that a jury summarily dismissed.

Also offering a keynote presentation is The Advisory Board Company on the playbook for population health followed by two panel discussions. Panel topics will cover compliance and risk, and medical transactions with private equity.

Panels will be moderated by Broad and Cassel Fort Lauderdale Managing Partner Gabriel Imperato and Partner Mike Segal, co-chair of the firm’s Health Law Practice Group. Additional Broad and Cassel attorneys joining the panels include Of Counsel Anne Branan and Senior Counsel O. Benton Curtis.

The Health Forum is sponsored by Broward County Medical Association, Dade County Medical Association, Palm Beach County Medical Society, ProAssurance Companies, PYA, South Florida Medical Group Management Association, South Florida Hospital and Healthcare Association, South Florida Hospital News, SunTrust and Withum.

What:

Seventh Annual Broad and Cassel Health Forum

The cost to attend is $90 and includes lunch and a cocktail reception following the presentations. To register, click here or contact Elizabeth Levine at elevine@broadandcassel.com or 407-839-4229.

When:

11 a.m.-6 p.m.   Wednesday, Oct. 11

11 a.m.             Registration and lunch

12 p.m.             Presentations begin

5 p.m.               Networking cocktail hour for participants, sponsors and speakers

Where:

Signature Grand, 6900 State Road 84, Davie, FL 33317

Broad and Cassel has built one of the most experienced and diversified Health Law Groups in the Southeastern United States. The firm has more lawyers certified in Health Law by the Florida Bar Board of Legal Specialization & Education than any other firm. Many of the firm’s health lawyers are certified by the Health Care Compliance Association in Health Care Compliance and are Certified Dispute Resolvers with the American Health Lawyers Association.

Information on the firm’s health law events and industry and attorney news can be found on Broad and Cassel’s Health Law Blog at http://www.healthlawfla.com or on Twitter at http://www.twitter.com/healthlawfla.

Posted in Health Forum | Tagged , , , ,

Medicare Fraud Strike Force Expands to Orlando

By: Mike Bittman

In July 2017, the Departments of Justice and Health and Human Services  opened a new Medicare Fraud Strike Force in Orlando, the third in Florida.

 

The original Medicare Fraud Strike Force opened in Miami in March 2007. Due to the success of the Miami Strike Force, and increased funding, DOJ and HHS opened Strike Forces in eight additional areas with high levels of billing fraud: Los Angeles, Detroit, Houston, Brooklyn, Baton Rouge, Tampa, Chicago, and Dallas. Since inception, the Medicare Fraud Task Forces have brought criminal charges against over 3,500 defendants who collectively falsely billed Medicare over $12.5 billion.

 

The Strike Force model consists of interagency teams made up of investigators and prosecutors that focus on the worst offenders engaged in fraud. The Strike Force uses  advanced data analysis techniques to identify suspicious billing levels, and targets schemes that migrate from one community to another. Members of the Orlando Strike Force include a prosecutor with the DOJ Criminal Division Fraud Section with Strike Force experience, prosecutors in the U.S. Attorney’s Office for the Middle District of Florida, FBI agents, HHS-OIG agents, and Florida law enforcement officials.

 

This expansion portends more federal criminal investigations and prosecutions in the Orlando area. Providers, suppliers, and contractors to Medicare, Medicaid, and TRICARE are well advised to increase their compliance efforts, including conducting thorough review and investigation of all reports of non-compliance. 

 

For more information on health care compliance, you may be interested in attending the 7th Annual Broad and Cassel Health Care Forum on October 11, 11:00 am – 6:00 pm, at the Signature Grand, 6900 State Road 84, Davie, FL 33317. You can register at this link:  http://events.r20.constantcontact.com/register/event?oeidk=a07ee5i4a0kc0991444&llr=gpww5cdab&showPage=true

 

Posted in Health Forum, Mike Bittman | Tagged , , , ,

Statewide Law Firm Helping Healthcare Clients Meet Challenges in a Rapidly Changing Environment

By: Daniel Casciato, South Florida Hospital News

Healthcare law can sometimes be complex since it encompasses a number of traditional law practices such as corporate and litigation. Also, since the industry is highly regulated, healthcare attorneys are often necessary to help you navigate this terrain.

With deep experience in the healthcare industry, the attorneys at Broad and Cassel LLP are committed to representing the best interests of its healthcare clients across Florida. One source of pride for the firm is its breadth and depth of experience in the health care practice group. The attorneys’ insight and knowledge of health law is based on years of hands-on experience in the public and private sectors, which are leveraged to help its clients overcome business challenges and meet its goals.

To continue reading, please visit South Florida Hospital News and Healthcare Report.

Posted in Practice News | Tagged , , , ,

How helping whistle-blowers could cut health-care costs

By: Warren Richey, Staff Writer for The Christian Science Monitor

Elin Baklid-Kunz never wanted to be a whistle-blower.

But working as the compliance officer at a Florida hospital, she was charged with identifying and correcting potential violations of US health-care laws.

Through conducting audits and studying regulations, she uncovered billing and other discrepancies. Each time she presented her findings to senior managers, however, they ignored her.

“I just thought if I worked harder they would see how bad this was and do something about it,” says Ms. Baklid-Kunz in an interview. “But as long as it cost them money [in reduced revenue and profits], they wouldn’t make any changes.”

To continue reading, please visit The Christian Science Monitor.

Posted in Compliance, Gabriel Imperato | Tagged , , , ,

Compliance Program Training for Your Board of Directors: What You Need to Know

By: Anne Novick Branan

Members of the Board of Directors[1] for health care organizations have important responsibilities related to corporate compliance. Government regulators expect health care Boards to assume greater responsibility to provide oversight for the corporate compliance programs and to promote an ethical culture in their organizations.  Failures in compliance programs that lead to criminal activities or improper billing expose an organization to substantial monetary and criminal penalties and further could expose individual Board members to personal liability.  Health care companies that provide effective education to Board members about their obligations related to the companies’ compliance programs can greatly minimize these potential liabilities.

The federal government’s message to health care providers is quite clear — if an organization deals with federal health care programs, the government expects the organization’s Board to be well educated and involved in the compliance program.  The Office of Inspector General for the Department of Health and Human Services (“OIG”) also made clear in recent corporate integrity agreements (“CIAs”)[2]  and published guidance that the federal government expects organizations to educate the Board members’ about compliance program duties and oversight responsibilities.  A typical CIA provision requiring such training may state:

The training shall address the corporate governance responsibilities of the board members and the responsibilities of board members with respect to review and oversight of the compliance program. Specifically, training shall address the unique responsibilities of the health care board members, including the risks, oversight areas, and strategic approaches to conducting oversight of a health care entity.  This training may be conducted by an outside compliance expert hired by the board and shall include a discussion of the OIG’s guidance on board member responsibilities.

CIAs usually require organizations to provide at least two hours of compliance program training for Board members.

The “OIG’s guidance on board member responsibilities” referred to in the CIA provision above can be found in an OIG publication, “Practical Guidance for Health Care Governing Boards on Compliance Oversight” issued April 20, 2015 (“OIG Guidance”).[3]  The OIG Guidance emphasizes the need for Boards to be fully engaged in the oversight responsibilities and offers practical tips for Boards as they work to effectuate their oversight role of the organizations’ compliance with State and Federal laws.  The critical element of the Board’s responsibility to stay informed on compliance matters is the Board’s obligation to ask the right questions of management to determine the adequacy and effectiveness of the organization’s compliance program.  Without sufficient training on its compliance-related obligations, a Board will be ill equipped to a make the meaningful inquiries of management and effectively exercise its oversight of organizational compliance.

However, how should health care companies provide such training and what should be included in the education? The OIG has stated that compliance program design and operation is not a “one size fits all” issue and that companies should tailor their compliance efforts to the size, complexity and culture of their organizations.[4]  Likewise, for compliance training, the organization should design and execute the training according to the organization’s and its governing body’s needs.

One approach is to provide an initial formal orientation and educational program for all governing body members that covers the key areas for compliance program oversight.   This program can be a part of a Board retreat, executive sessions or provided in regular board meetings.  At least two hours of initial training is advisable, but ongoing follow-up training and education is needed if the Board’s oversight of the compliance function will be effective.  Health care companies may provide the training with internal resources, typically through the organization’s chief compliance officer (“CCO”) or hire a compliance consultant or expert to conduct or assist with the training.

Many health care companies decide to hire a compliance expert to perform the Board education and training and this approach has certain advantages.  First, the OIG favors the use of outside compliance experts in its CIAs and the OIG Guidance, stating

Board members are entitled to rely on the advice of experts in fulfilling their duties.  OIG sometimes requires entities under a CIA to retain an expert in compliance and governance issues to assist the board in fulfilling its responsibilities under the CIA.  Experts can assist Boards and management in a variety of ways, including the identification of risk areas, provision of insight into best practices in governance, or consultation on other substantive or investigative matters.[5]

Using an outside expert can lend additional credibility to the training, especially for discussion involving legal standards for Board decision-making and the complex web of state and federal laws that apply to health care companies.   Health care consultants save the organization and CCO time and money by planning, preparing and performing the training, as well as providing educational materials and answering specific questions from Board members.  Moreover, Board members may feel more comfortable addressing questions with someone outside their organization about their concerns about potential personal liability and their responsibility for compliance.

The content of the initial training and orientation to the Board’s compliance program obligations should include at a minimum the following:

  1. The Board’s fiduciary duties. The training should effectively educate directors as to their various fiduciary duties in connection with the compliance function.  At a minimum, directors should be advised as to the duties of care and good faith dealings, including a duty of reasonable inquiry.[6]
  2. The organization’s compliance program. The Board must be trained on the structure and operation of the company’s compliance program.  According to the OIG Guidance, the Board should ensure that the structure includes, as a key compliance program element, a corporate information and reporting system.[7] Such a system not only keeps Board members informed of the activities of the organization, but also enables an organization to evaluate and respond to issues of potentially illegal or otherwise inappropriate activity.[8]
  3. Laws and regulations relevant to the organization. Companies should develop a formal plan to ensure that their Boards stay abreast of the ever-changing regulatory landscape.  The plan may involve periodic updates from the CCO, or consultants or attendance at industry educational programs. Board education should address legal authorities that generally apply to health care industry, as well as those specific to the organization’s industry segment, such as home health or physician group practices. Board members need to know about the False Claims Act,[9] Stark Law[10] the Federal Anti-Kickback Statute,[11]  the Health Insurance Portability and Accountability Act of 1996 and regulations[12] and other privacy laws, and federal program exclusion screening requirements, as well as applicable state laws that affect compliance.
  4. The Board’s responsibility for promoting a compliant culture within the organization. Training should emphasize the role of the governing body in setting the tone for an organizational culture that fosters integrity and ethical conduct based on overreaching company values.  Board members should understand that they are expected to adhere to the code of conduct and serve as examples of compliant and ethical behavior.    The organization should educate the Board on its obligation to encourage a level of compliance accountability across the organization.

As proof of its effective Board training, organizations are well advised to develop and implement a formal plan for annual training, regular compliance program updates and ongoing education, as well as a system of documenting such training.  Board meeting notices, agendas and minutes are key places to document the training. Recordkeeping should include qualifications for compliance educators and training materials used and distributed in annual training and ongoing education efforts.

In today’s aggressive enforcement climate, the Board members at the helm of health care organizations must be well informed and trained to execute their compliance program oversight responsibilities.  Whether the company chooses to use internal resources for such training or engage a compliance expert, the investment will certainly pay off in a more effective compliance effort and mitigated potential for liability arising from non-compliant conduct.

[1] While we discuss the obligations of “Boards of Directors” of corporations in this article, the obligations apply to the members of governing bodies of any entity operating a health care provider.

[2]   A CIA is an agreement between the OIG and a health care provider that typically settles a fraud investigation and imposes obligations on the provider to develop and implement compliance measures to address the conduct under investigation. See Corporate Integrity Agreements between OIG and Ortho-McNeil-Janssen Pharmaceuticals, Inc. (2010); Synthes, Inc. (2010).

[3] OIG et al., Practical Guidance for Health Care Governing Boards on Compliance Oversight (2015).

[4] OIG, et al., supra note 3 at 3.

[5] OIG, et al., supra note 3 at 5.

[6] In re Caremark Intern, Inc. Derivative Litig., 698 A.2d 959 (De. Ch. 1996); Stone ex rel. AmSouth Bancorporation v. Ritter, 911 A.2d 362 (De. 2006); American Health Lawyers Association, The Health Care Director’s Compliance Duties: A Continued Focus of Attention and Enforcement, 5 (2011).

[7] Such a reporting system may include an anonymous hotline to allow individuals to report suspected non-compliance.

[8] OIG, et al., supra note 3 at 2.

[9] 31 U.S.C. §§ 3729-3733.

[10] 42 U.S.C. § 1395nn.

[11] 42 U.S.C. § 1320a-7b(b).

[12] 45 CFR Parts 160 and 164.

Posted in Anne Novick Branan, Compliance | Tagged , , , , , , ,

Broad and Cassel Health Law Practice Achieves Band One Ranking in Chambers USA 2017

ORLANDO, Fla. (June 16, 2017) — For the seventh year in a row, the Health Law Practice Group at Florida-based law firm Broad and Cassel LLP has once again received top honors within Florida by prominent legal guide Chambers USA: A Guide to America’s Leading Business Lawyers. The firm’s practice group was one of just two receiving a Band One ranking in the state, the highest ranking awarded by Chambers USA.

All told, the firm’s nationally recognized group saw the ranking of six individual attorneys, more than any other firm in the state, in addition to the group’s collective Band One ranking. Ranked attorneys include Managing Partner Gabriel Imperato, Partner Mike Segal, Partner Michael Bittman, Partner Lester Perling, Partner Stephanie Russo, and Of Counsel Stephen Siegel. Imperato, one of the group’s leading attorneys, received national recognition in health care, ranking among the best in the country for his work in health care regulatory and litigation.

To continue reading, please click here.

Posted in Gabriel Imperato, Honors and Awards, Lester Perling, Mike Bittman, Mike Segal, Practice News, Stephanie Russo, Stephen Siegel | Tagged , , , , ,