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Austin Texas Legal Issues Blog

OIG and coronavirus funds: 2 enforcement efforts in action

The current coronavirus pandemic has led various federal government programs to provide funds to struggling businesses. Some of these funds are set aside specifically for health care businesses. These funds often come with restrictions and improper use can result in fines and allegations of wrongdoing.

Some health care companies return federal funding

The United States Centers for Medicare and Medicaid Services (CMS) sent out federal funding to help qualifying businesses within the health care marketplace. These funds were part of the Coronavirus Aid, Relief and Economic Security Act. In an effort to better ensure medical care providers received the funds promptly, the agency decided to proactively deposit $30 billion to providers who had recently filed claims with Medicare.

Pharmacy owners, marketers and health care fraud

How pharmacies classify and pay their workers can cause questions and may lead to a federal investigation. A recent case provides an example.

Issue #1: One pharmacy or two?

The prosecution states the pharmacy owners claimed to have two separate pharmacy businesses. In reality, the government states these businesses were "separate in name only." They claim the businesses used the same staff, same marketers and same building. 

3 myths about home health care fraud

The ability to have a medical professional come into one's home and provide care to those who are suffering from diseases like Parkinson's, Alzheimer's and others is growing in popularity. This relationship, like any other that results in billing Medicare and other insurance providers, can result in allegations of health care fraud. There are many myths that abound around health care fraud and the home health care system, but three of the more common include:

Texas Board of Nursing warns against balance billing

The Texas Board of Nursing (BON) recently reminded nurses of the consequences that can come with balance billing. Texas lawmakers recently changed the rules that govern balance billing, also known as surprise billing, with Senate Bill 1264. Lawmakers wrote the bill to protect consumers from unexpected medical bills and went into effect January 1, 2020.

What is an “elective” medical procedure?

Governor Greg Abbott recently issued an executive order that requires medical professionals to postpone all surgeries and procedures that are “not immediately medically necessary to correct a serious medical condition of, or to preserve the life of, a patient who without immediate performance of the surgery or procedure would be at risk for serious adverse medical consequences or death, as determined by the patient’s physician.”

There are exceptions. For example, the executive order does not apply to procedures that would not deplete personal protective equipment or hospital capacity. Office based visits may also be exempted, as long as they are done within accordance of the standard protocols.

HHS relaxes HIPAA requirements during COVID-19

The coronavirus pandemic has impacted hospitals and private practices in many ways. Leaders in these organizations need to change how they operate their practices to better ensure patients receive the care they need while also reducing the risk of exposure to the virus for patients and medical care providers.

These new methods of operation may make it difficult to manage typical information security protocols. Various government agencies have recognized this reality and adaptations to regulations are the in the works. For example, the Office for Civil Rights of the United States Department of Health and Human Services (HHS) recently announced a relaxation of penalties for potential violations of the Privacy, Security, and Breach Notification Rules under the Health Insurance Portability and Accountability Act (HIPAA).

3 things to know about TMB’s response to Executive Order GA-09

Governor Abbott recently issued Executive Order GA-09 in response to the current coronavirus pandemic. The order essentially requires all licensed health care professionals to postpone elective procedures in an effort to better ensure the availability of hospital facilities and protective equipment to assist those who fighting COVID-19.

Can public intoxication lead to loss of a medical license?

Having a few too drinks many can lead to some bad choices. If these bad choices catch the eye of the police, this moment to unwind after a long day can also translate to an arrest for public intoxication.

Even if no one is injured, the allegations can have serious consequences for those who practice medicine.

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