Tag Archives: recovery

Zoning – Cities Can’t Discriminate Against Providers

Once again (and again, and again), the NIMBY (Not In My Backyard) and the CAVEmen (Citizens Against Virtually Everything) pitchforks came out in mass to protest a methadone clinic opening in Philadelphia, notwithstanding that methadone clinics are otherwise allowed.

“The court also used a Third Circuit finding to bolster its conclusion, citing a 2007 ruling that found that municipalities are not free to hold methadone clinics to different zoning standards than ordinary medical clinics.”

There is no basis to treat medical and health clinics any differently from substance abuse clinics, but for the type of person to be treated.

I often find it comical (not really) when I bring to NIMBY’s attention that a MOD (medical office building) permits psychiatrists who have the right to see would-be mass murderers and potential child molesters, but heaven forbid people seeking recovery and solace from the scourge of drug abuse seek similar (if not less intense) medical and behavioral care, and the pitchforks and torches come off the shelves.

Check out this LAW360 article:
Pa. Court Says Philly Zoning Can’t Preclude Meth Clinics

Prompt Pay Laws

Many have been calling in recent days regarding insurance carriers refusing to pay for claims for treatment, essentially saying “sue us for your money.” Aside from potentially discriminatory undertones, this is patently illegal.

The State of Florida has what are known as “Prompt Pay” laws which require an insurance carrier to do just that. While I won¹t get into the details here, I thought I would share this article with you to illustrate that ³you are not alone² when it comes to this headache.

Read more about them with Law360’s article:
Hospitals Can Sue Under Prompt Pay Law: NY Appeals Court

Wellington town hall meeting to address ‘sober homes’

Anyone with an interest should absolutely attend this meeting. Don’t let it be a one-decided discussion. Let them see the “Faces of Recovery” as well as hear from you that you and those you compassionately serve will not tolerate being treated as a second-class citizen due to your/their disability. I am reminded the following poem “First they came” is a famous statement and provocative poem attributed to pastor Martin Niemöller about the cowardice of German intellectuals following the Nazis’ rise to power and the subsequent purging of their chosen targets, group after group.

First they came for the Socialists, and I did not speak out– Because I was not a Socialist.

Then they came for the Trade Unionists, and I did not speak out– Because I was not a Trade Unionist.

Then they came for the Jews, and I did not speak out– Because I was not a Jew.

Then they came for me–and there was no one left to speak for me.

Get details here!

Roslyn Carter

In 1966, the idea of advocating for people with mental illnesses was even less popular than it is today, cloaked in shame, stigma, and discrimination. Mrs. Carter took it on anyway and for the past four decades has addressed issues related to consequences of mental illness that cry out for reinvention and transformation. She seems to come from a place that overrides fear and shame and goes right to compassion. And it’s the compassion that has fueled her commitment to a segment of our population that had been dismissed as having nothing meaningful to contribute to our society and needing nothing more than to be taken care of.

Behavioral Health recently wrote a great article that we would recommend: Rosalynn Carter: Stigma has ‘a long way to go’

OIG’s 2014 plan promises scrutiny for behavioral health

By Dennis Grantham, Editor-in-Chief of Behavioral Healthcare

In a recent story, “Compliance programs stress effectiveness” (Behavioral Healthcare, Nov./Dec. 2013 issue), Fabio van der Merwe, director of quality improvement and compliance at DeKalb Community Services Board (Atlanta, Ga.) noted that each year, the Office of the Inspector General (OIG) for the Department of Health and Human Services releases an annual work plan.
This plan, he says, “puts compliance officers ‘on notice’ as to the focus of federal Medicare and Medicaid enforcement activity for the coming year.” In its recently unveiled 2014 work plan, the OIG committed to continuing a range of investigative activities involving behavioral health.

Read the full article here.

Letter from DCF RE: Patient Brokering

Many of you have called me regarding letters you may have received from DCF regarding Patient Brokering. Please be aware that the letter has been sent to all providers and not to anyone specifically accused of any wrongdoing.

That said, you should remain vigilant that you are closely monitoring any activity by your staff that could be construed to violate s. 817.505, Fla. Stat., the Patient Brokering Act. I have attached a copy for your records.

For purposes of the Act, the repeat question I receive is regarding how to effectively and legally use marketing companies to obtain referrals for new patients. The provision in the statute which addresses that point can be found within subsection (i) which allows for:

Payments by a health care provider or health care facility to a health, mental health, or substance abuse information service that provides information upon request and without charge to consumers about providers of health care goods or services to enable consumers to select appropriate providers or facilities, provided that such information service:

1. Does not attempt through its standard questions for solicitation of consumer criteria or through any other means to steer or lead a consumer to select or consider selection of a particular health care provider or health care facility;

2. Does not provide or represent itself as providing diagnostic or counseling services or assessments of illness or injury and does not make any promises of cure or guarantees of treatment;

3. Does not provide or arrange for transportation of a consumer to or from the location of a health care provider or health care facility; and

4. Charges and collects fees from a health care provider or health care facility participating in its services that are set in advance, are consistent with the fair market value for those information services, and are not based on the potential value of a patient or patients to a health care provider or health care facility or of the goods or services provided by the health care provider or health care facility.

Should you have any questions or concerns about your compliance with this provision, please don’t hesitate to give us a call.

Senate Bill 582 – Amended – Revised Staff Report

The fiscal impact issue has finally been addressed, again. And it says the same thing as the legislation did last year. Hence, another reason why we are called Flori-DUH.

The bill would have a significant fiscal impact on DCF. The number of sober houses statewide that would apply for certificates of registration and require initial and ongoing inspections and administrative oversight is unknown.

Similar to proposed legislation introduced in 2013 (SB 738), the department cannot determine the exact fiscal impact of this bill. The number of sober homes that would require inspection and the number of background screenings that would require review is unknown. Additionally, the department would need funding to modify its existing licensure database and pay for additional data storage capacity at the shared resource center. The department would need staff to perform inspections, process applications, review background screenings, provide legal representation in chapter 120 proceedings in the event of a denial, revocation or suspension of a registration and update its licensing and technology systems.

In 2013, the department estimated it would need 65 new positions to perform all the identified tasks at a cost of $6.8 million and $200,000 to modify its licensing and technology systems for a total impact of $7 million.

Get full details here.

Insurance Fraud – More Fraud in the Substance Abuse Drug Screening Urinalysis Industry

Meant to include this one earlier, brought to our attention from our friends over at PathologyBlawg.com

A chain of opiate addiction recovery centers, headquartered in Harrodsburg, Ky., and a Russell Springs, Ky., clinical laboratory, along with two physician owners, agreed to pay the U.S. Government millions of dollars to resolve civil allegations that they fraudulently billed federal health care programs for medically unnecessary and excessive urine tests.

Strangely, DOJ and the states Attorney Generals don¹t see to be concerned about the same abuse in the private insurance sector.

However, something to chew on – are medical plans obtained through the Federal Healthcare Exchange (or a state exchange) elevated to a federal health care program. I assume the answer is “no” as a mere result of legal definition, but we will wait and see.

Still, the fox appears to be the only one watching the hen house.

Check out these articles:
Kentucky Addiction Treatment Center, Clinical Laboratory and Two Physician Owners to Pay $15.75 Million to Resolve Allegations of Fraudulent Urine Drug Testing

Attorney states cash kickbacks from urine drug screen lab are perfectly legal

Blue Cross Accuses Drug Test Co. Of $36M Fraud Scheme