Tag Archives: sober news

How to Reconcile Integration with Anti-Kickback Laws and Market-Based Compensation

“Many hospitals are hiring and contracting with doctors to boost referrals and serve members in their coordinated-care networks. But how to pay those doctors has become a legally perilous area under the federal Stark and anti-kickback laws and the False Claims Act, with whistle-blowers, their attorneys and the Justice Department watching these transactions closely. Halifax and other recent big-dollar whistle-blower cases involving allegations that hospitals violated Stark self-referral rules in paying physicians highlight the huge stakes for hospitals, which are at risk for triple damages under the False Claims Act. Those damages are based on total billings, making the potential damages in these cases enormous.”

“The tough part for hospital leaders is that these legal pressures are at odds with public policy and market forces pushing health systems toward greater integration to improve care coordination and reduce costs. The federal government hasn’t reconciled its goal of encouraging integration with its desire to prove that it’s tough on fraud and abuse. As a result, systems pursuing integration will need to be even more vigilant because they’re stepping closer to the line where traditional Stark law enforcement might come into play.”

Read the full story here:
http://www.modernhealthcare.com/article/20140308/MAGAZINE/303089982/caught-between-competing-pressures?AllowView=VXQ0UnpwZTVDZlNXL1I3TkErT1lBajNja0U4VUNlWlZFQk1JQmc9PQ==&utm_campaign=am

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

Further Discussions on the Marketplace Impact of the Affordable Care Act

As initially predicted, the marketplace is moving towards consolidation of services and this may likely begin to see capture in the substance abuse treatment services in the coming 12-36 months. Possibly later.

The trends leading to this uptick in deals over the past year or so increasing health care costs, growing demand for services, consolidation of doctor groups were in place before the law. But experts say the ACA magnified their importance and expedited hospitals’ response.In one sense it just means there’s a higher need for medical office buildings. At the same time, hospitals are trying as they acquire physician groups to gain market share and use the physicians as a gateway into the market, said Ross Yustein, chair of Kleinberg Kaplan Wolff & Cohen PC’s real estate group, which has an unusual expertise in medical office building development deals.

Read this article about Hospitals Turn To Off-Campus Offices Under ACA

PALM BEACH LEGISLATORS WANT OVERSIGHT ON SOBER HOMES

As part of my ongoing commitment to keep Palm Beach County safe Sen. Jeff Clemens and I are gaining even more support on our bill regarding sober homes. According to Delray Beach city rental housing inspector Marc Woods, only half of Delray Beach’s 550 sober homes have complied with a law the city has imposed to verify the number of tenants living in rental homes. Additionally, people coming to the city for recovery are estimated to have committed over half of the property crimes seen in Delray Beach in the past year. Delray Beach is not the only city with this concern; all of Palm Beach County could be at risk – unless we act now.²

These ³facts² remains anecdotal, speculative, and stereotypical at best, and discriminatory and unfairly stigmatizing at worst.

Let me be clear, I strongly support legitimate and targeted regulations to ensure that persons in recovery are protected from predatory landlords and unscrupulous treatment providers.

But throwing cavalier statements around about people in recovery causing 50% of the crime in Delray Beach is absolutely absurd, reckless, and quite frankly, continues to paint the City of Delray Beach (and now, this specific legislation) in the light of a government hell-bent on getting rid of ³those people² at all costs.

Marc Woods should be ashamed of himself.

See the press release below:

FOR IMMEDIATE RELEASE: FOR MORE INFORMATION:
January 8, 2014 Chauncey Graham (561) 540‐1140
PALM BEACH LEGISLATORS WANT OVERSIGHT ON SOBER HOMES

TALLAHASSEE, FL ‐‐‐ Florida State Senator Jeff Clemens (D‐Lake Worth) and Representative Bill Hager (R‐Delray Beach) hope to put the brakes on the unchecked proliferation of “sober homes” that are changing the character of neighborhoods around the state.

Many communities have been virtually overrun by the number of so‐called “sober homes” that have emerged in the middle of neighborhoods. These unregulated facilities can potentially house twenty to thirty individuals renting space from a landlord with an eye more to maximizing profits than providing actual treatment, and they can also attract criminal elements such as drug dealers hoping to sell to residents.

While some city officials claim that thousands of these homes have opened across the state, the data is unreliable because the state has no means of tracking sober homes. SB 582 and HB 479 will allow the state to track sober house transitional living homes by providing rules for the registration and operation of these type of substance abuse service facilities.

“While many businesses are restricted from operating within single‐family neighborhoods, sober homes can open virtually anywhere,” Clemens said. “Some of these so‐called homes are destroying neighborhoods and providing little benefit to residents or the community. We need to get a handle on the problem.”

“Dating back to my service on the Boca Raton City Council, I have been keenly aware of the neighborhood challenges relating to so‐called sober homes. It is time to take legislative action,” Hager said. “Our proposal regulates sober homes in terms of licensing, screening those who operate these homes and gives the Department of Children and Family Services the ability to inspect the homes on a regular basis. Way too many problems have been reported to local officials in connection with some of the sober homes to permit them to continue to operate without regulation.”

Currently, sober homes can be established anywhere by anyone and, while claiming to provide assistance for recovering addicts, oftentimes do not offer treatment programs or services. The proposed legislation will outline where and how sober homes can be operated and address public safety issues that result from poorly run facilities.