Recent Publications
On the close of the 2019 session, the NYS Legislature passed sweeping changes to the State’s discrimination laws that will make it easier for employees and outside contractors who interact with those employees, to bring and sustain discrimination claims.
In today’s healthcare climate, many providers have been subject to an audit by Centers for Medicare & Medicaid Services (CMS) whereby CMS (through one of its contractors) requests a sample of records and subsequently determines that the documentation does not substantiate the codes billed. Accordingly, CMS requests that money be “repaid” in connection with the services previously provided and paid. In some instances, CMS limits the overpayment request to those documents it has actually reviewed, while in other instances CMS takes the amount involved and corresponding error rate and “extrapolates” that amount to extend over a larger universe of claims spanning several years, resulting in a significantly increased overpayment demand which can be millions of dollars.
The newly enacted federal Eliminating Kickbacks in Recovery Act (“EKRA”) impacts the way healthcare providers may compensate certain employees and referral sources. EKRA prohibits healthcare providers from giving or receiving remuneration for referring a patient to a recovery home, clinical treatment facility or laboratory. For purposes of EKRA, a “clinical treatment facility” is defined as “a medical setting, other than a hospital, that provides detoxification, risk reduction, outpatient treatment and care, residential treatment, or rehabilitation for substance use, pursuant to licensure or certification under State law.” A violation of EKRA may lead to fines of up to $200,000 and up to 10 years imprisonment. Accordingly, healthcare providers should evaluate the structure of their current arrangements with certain employees and referral sources.
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