Holland & Hart Healthcare Law Blog

RAC AUDITS AND NEW FEDERAL FALSE CLAIMS ACT EXPOSURE.UNDER THE FRAUD ENFORCEMENT RECOVERY ACT OF 2009 (“FERA”).

The federal squeeze of health care providers is underway. Federal Medicare recovery “bounty hunters,” the Recovery Audit Contractors (“RAC”), are marshalling resources for the anticipated, algorithm primed, data mining hunt for Medicare overpayments from hospitals, physicians, DME companies, hospices and other providers, which is likely to bloom in the second half of this year. Those that attempt to mislead the government or its computer toting agents in order to limit the harvest are facing additional potential exposure under the Federal False Claims Act, 31 U.S.C. §3729-3733 (“FCA”).

STATE CANNOT REDUCE MEDICALLY NECESSARY HOME HEALTH COVERAGE UNDER MEDICAID.

In Anna C. Moore v. M.D. Rhonda Medows, No. 107-CV-631 TWT (D.C.N.D. Georgia-Atlanta Div. June 4, 2008), an action for declaratory and equitable relief brought by a 12 year old Medicaid patient under 42 U.S.C. §1983, the U.S. District Court granted Ms. Moore summary judgment against the State of Georgia which sought to reduce the number of home duty nursing hours afforded the plaintiff from 94 prescribed by her doctor to 84 hours a week as a cost cutting measure.

$365,000.00 Penalty To Nursing Home Cited For Short Staffing Resulting in Death.

The 6th Circuit Court of Appeals affirmed a Civil Money Penalty Judgment against a nursing home in Ashbury Center v. Department of HHS, 6th Cir. No.02-3438 for the Center's failure to provide adequate supervision posing immediate jeopardy to two residents health and safety. Both residents fell down stairwells while strapped into wheel chairs. 42 C.F.R. Section 488.301 defines immediate jeopardy as a situationin which the provider's noncompliance with one or more requirements of participation has cause serious injury or death to a resident. The judgment affirmed the finding of the administrative law judge below that the Center's care did not comply with Medicare regulations requiring that corridors not be left unsupervised for indefinate periods and that adequate staffing be maintained.