An Austin Firm Dedicated to Health Care Law

Austin Texas Legal Issues Blog

Texas family loses ranch in healthcare fraud case

A family operation faced accusations of healthcare fraud in Dallas. The operation, Anderson Optical & Hearing Aids Center, allegedly defrauded Blue Cross Blue Shield of Texas of over $16.7 million. A father and son run the facility. The father was convicted on 15 counts for healthcare fraud and identity theft. The son, 13 counts for the same crimes.

What did the prosecution argue? The prosecution claimed the father and son duo would test patients for hearing loss and tell the patients that had slight to mild hearing loss. The patient would then sign an order form for a hearing aid. In exchange for the signature, the prosecution argued, the patient would get a free pair of sunglasses.

Legal advocacy is necessary when a medical investigation beckons

It is understandable that health care professionals and health care providers are under constant scrutiny for the service and work they provide. Medical care is highly specialized, and any mistake or issue that may arise could lead to serious complications for patients. But at the same time, medical professionals need to be protected from frivolous or otherwise unnecessary claims of malpractice, substandard care, or other violations of the law.

Depending on the scale of the violation and the specifics of each case, the Office of the Inspector General (OIG), the Federal Bureau of Investigation, or even the Medicaid Fraud Control Unit could launch an investigation into an individual or a business in the health care industry.

Will you meet the requirements for a home health care agency?

If you are planning to open a home health care agency in the state of Texas, you will first have to meet the licensing requirements.

The Texas Department of Aging and Disability Services will want to know all about your background, your plans for the agency, your personnel and more.

What to expect

In order to become a licensed home health care agency, you must complete what the state refers to as pre-survey computer-based training and complete the license application. As the owner of the company, you must also fill out Form 2022, which constitutes a Licensure Criminal History Check. Next, you must provide the organizational structure of your agency and submit resumes for yourself and supervising nurses. You must also submit continuing education certificates for the administrators. In addition, you must be certified for Medicare programs so as to provide services to people who are eligible.

Federal regulators step up enforcement at nursing homes

The Nursing Home Reform Law of 1987 states that a nursing home facility is not allowed to transfer or discharge a resident unless it can establish certain criteria. This law was passed as a result of complaints by residents throughout the country about evictions.

These complaints have increased in recent years. The United States Department of Health and Human Services reports 140,145 complaints about discharge and eviction issues. In response, regulators sent a memo to officials throughout the country to review discharge, eviction and transfer of residents from nursing home facilities during inspections.

Trump administration ramps up physician investigations

Managing pain is a difficult task. There are no bright line rules. Physicians must listen to their patients and use their training combined with their best professional judgment to come up with a plan. This plan may include the use of prescription narcotics like opioids.

Our country is currently in the midst of an opioid crisis. President Donald Trump is taking steps to address this problem. Although the goal of ending this crisis is a noble one, the methods may be flawed.

Medicare officials say they wrongly paid for chiropractic care

As you know, aches and pains come with the territory as you age, but it does not mean your clients have to take it lying down. They have every right to continue living an active and passionate life as pain-free as possible, which often means regularly seeing their chiropractors. As you and many other Texans are aware, good chiropractic care can make the difference between suffering through chronic back and extremity pain and feeling on top of the world.

Unfortunately, Medicare does not see it this way. The Centers for Medicare and Medicaid Services claims to solely pay for services that are medically necessary, and it does not consider maintenance therapy, in other words, the bi-monthly chiropractic adjustments that keep your clients aligned and moving freely, to be a necessary service.

Nurses in Texas: Lots of debt could mean no license

It seems astonishing to even consider, but many nurses and other professionals with student loan debt in Texas could lose their licenses to work if they fall into trouble with that debt. The idea is that if nurses know their job is at risk, they will find a way to pay that debt.

It might be a decent idea in theory, but is it effective in reality? With some people, it can be. In many cases, though, it is not. After all, if nurses could afford to pay back their loans, they would already be doing so. Is it fair to ask a nurse to choose between groceries and rent or a student loan payment?

Texas nurse practitioner's license temporarily suspended

Two-hundred and fifty miles east of Austin sits the Texas city of Nederland on the border with Louisiana. A nurse practitioner there recently had his license suspended by the Texas Board of Nursing.

The nurse practitioner worked at a hormone therapy clinic. The board found that he failed to meet the standard of care in his treatment of 11 patients there. The three-member panel voted unanimously to suspend his license pending a probable cause hearing by the State Office of Administrative Hearings scheduled next month.

Important Notice for Medicare Providers: Medicare Beneficiaries Identifier is replacing Social Security number

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 mandates removal of Social Security Number (SSN)-based HIC numbers from Medicare cards to address current risk of beneficiary medical identity theft. CMS will use a new MBI generator to assign over 150 Million MBIs beginning April 1, 2018, and continuing through December 31, 2019, for full implementation January 1, 2020. While CMS will continue to process transactions utilizing a beneficiary's current HIC number during the transition period, Medicare fee for service entities must modify their current processes and systems to be ready to submit or exchange the MBI by April 1, 2018. The current system requires a 9-byte SSN plus 1 or 2-byte BIC. The MBI system will require an 11-byte alpha numeric numeration system. All Medicare fee for services entities are advised to check all of their internal billing systems to be certain the software they are currently using will accommodate the new MBIs. During the transition period, Medicare entities will be allowed to enter either the MBI or HIC number. If you use vendors to bill Medicare, ask them about their MBI practice management system changes and make sure they are ready for the change.

Crunching Texas Medical Board numbers

The Texas Medical Board is responsible for the licensing and regulation of doctors in our state. It also oversees acupuncturists, physician assistants, radiologists, respiratory care practitioners and others.

The board recently released information on the number of complaints it received in fiscal year 2017 about doctors and other health care personnel over which it has jurisdiction. According to the data, the board received 8,114 complaints -- the highest total since 2011.

Privacy Policy | Business Development Solutions by FindLaw, part of Thomson Reuters.

back to top