Articles
New Process for Appealing Medicaid MCOS’ Adverse Claim Determinations
House Bill 492 – New Process for Appealing Medicaid MCOs’ Adverse Claim Determinations On June 7, 2017, Louisiana House Bill 492 (HB 492) was sent to the Governor for executive approval. This Bill establishes a …..
Living with Billeaudeau
Hospitals across the state have been grappling with the ramifications of the Louisiana Supreme Court’s recent decision in Billeaudeau v. Opelousas Gen. Hosp. Auth., et al., 2016-0846 (La. 10/19/16) 218 So.3d 513. In that case, …..
$5.5 Million HIPAA Settlement Underscores Importance of Audit Controls
Memorial Healthcare Systems (MHS) paid the U.S. Department of Health and Human Services (HHS) $5.5 million to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules …..
Final Rules on Reimbursement for Off-Campus Provider Based Departments
On Nov. 2, 2015, Congress surprised providers with the passage of Section 603 of the Bipartisan Budget Act of 2015 (the “Act”), which eliminates Medicare Outpatient Prospective Payment System (OPPS) reimbursement for off-campus outpatient provider-based …..
Negligent Credentialing of Physicians: Increased Liability for Hospitals
The Louisiana Third Circuit recently held in Billeaudeau v. Opelousas General Hosp. Authority, 189 So. 3d 561 (La. App. 3d Cir. 2016) that a claim for “negligent credentialing” of a physician by a hospital does …..
Department of Justice Doubles Health Care Civil Fraud Penalties starting August 1, 2016
The U.S. Department of Justice (DOJ) published an interim final rule on June 30th that dramatically increased potential civil penalties under the Civil False Claims Act and the Federal Anti-Kickback Statute. Currently, violations of the …..