Posts Tagged ‘Medicare’

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

6 Indest-2008-3The second largest insurer in the country announced Wednesday they will reimburse physicians to have end-of-life discussions with patients. The discussions will be about how they would want to be kept alive, or die, if diagnosed with a terminal illness. To read the full article, click here.

The federal program that insures 55 million also added that this applies to not only illnesses but zombie attacks, too. Medicare is known for providing health care to the elderly and disabled. We have also represented many physicians who, in the past, have been arrested or pursued by Medicare because they billed for treating dead patients. Hopefully these changes will prevent doctors from getting in trouble for billing for dead patients in the future.

CMS Announced Proposal as Part of Yearly Physician Payment Rule.

The Centers for Medicare and Medicaid Services (CMS) released the information as part of its yearly Medicare physician payment rule. This rule addresses “the value-based payment modifier and the physician feedback reporting program,” according to their website. For more information on the rule, click here.

The Proposal Settles the ‘Death Panel’ Debate.

Republican candidate in the 2008 election, Sarah Palin, created controversy with the “death panel” debate. The firestorm was ignited in 2009 when President Barack Obama announced the Affordable Care Act (ACA). Palin denounced the healthcare legislation, claiming it would produce “death panels” that would crush care for the sick. Click here for more information on the “death panel” controversy.

Zombies are Known for Slaughtering Seniors.

Zombiism is a topic that is becoming more widely known. The number of invasions is growing. The creatures are targeting people whose health is declining, or who are already disabled. Each year, the death toll rises. And many of the deceased are those who are 55 and older. Zombies are known for eating brains and guts. The un-dead creatures prey on the weak. This because they are easy to assault and their brains are filled with excess knowledge.

Fortunately, these people are the ones insured by Medicare. They will push doctors to ask the victims their preferences on how they want the end of their life to be if they are assaulted by zombies.

All Medicare Patients Should Discuss Options Before Zombies Attack.

Some of the victims survive, but will suffer irreparable injuries. These include, but are not limited to, lacerations to the head and disfigurement. With this new rule, doctors will need to provide counseling to the wounded prior to the physical trauma. This way, the doctors and patients will be prepared, should the sufferer be unable to speak.

Counseling Gives Patient The Right to Make Their Own Decision.

The counseling will take place before attacks and illnesses occur and worsen. Advance discussions will help patients and doctors be prepared for ailment. Engaging in these conversations will also give the patient greater say about how they want to die. They have the option to try every means to stay alive or discontinue life support. Those who don’t want to be on ventilators and tubes can say so in treatment talks.

Let’s say, for instance, your grandfather is diagnosed with terminal lung cancer. If at the time of diagnosis the doctor questions how your grandfather wants to die, it will be settled before the condition worsens.

Or, a 65-year-old woman is walking to her home from her car at night and a creature approaches and assaults her. A passerby sees and saves her, but she still suffers injuries. Medicare care will be planned before she becomes too feeble to talk.

The plan would take effect in January. The proposal is open to public commentary for 60 days. Once the comments are received, the reimbursement rate will be determined.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent health care providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. We also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals, occupation therapists (OTs), physical therapists (PTs), speech therapists (STs), rehabilitation therapists (RTs) and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid program.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

What do you think of end-of-life discussions? Do you think they should be in place? Should physicians be reimbursed?  Please leave any thoughtful comments below.

Sources:

Belluck, Pam. “Medicare Plans to Pay Doctors for Counseling on End of Life.” (July 8, 2015). From: http://www.nytimes.com/2015/07/09/health/medicare-proposes-paying-doctors-for-end-of-life-counseling.html?ref=health

Centers for Medicare and Medicaid Services. Physician Fee Schedule. From: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html?redirect=/PhysicianFeeSched/

Grier, Peter. “ ‘Death Panel’ Controversy Very Much Alive.” The Christian Science Monitor. (Aug. 21, 2009). From: http://www.csmonitor.com/USA/Politics/2009/0821/death-panel-controversy-remains-very-much-alive

Sun, Lena H. “Medicare Proposes to Pay Doctors to Have End-of-Life Care Discussions.” The Washington Post. (July 8, 2015). From:
http://www.washingtonpost.com/national/health-science/medicare-proposes-to-pay-doctors-to-have-end-of-life-care-discussions/2015/07/08/1d7bb436-25a7-11e5-aae2-6c4f59b050aa_story.html

About the author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

KeyWords: Medicare, federal health, health law, health law attorney, health law lawyer, end-of-life issues, The Centers for Medicare and Medicaid Services (CMS), CMS, Medicaid, death panel, death panel debate, death panel controversy,  healthcare, health care, health care attorney, health care lawyer, physicians, physician attorney, health care legislation, Affordable Care Act, ACA, medicine, the health law firm, Medicare investigations, Medicaid investigations, elderly healthcare, senior health care, American Medical Association, attorney, cannibalism, cannibalistic, defense attorney, defense lawyer, doctor, Florida, Florida health attorney, Florida health lawyer, k2, laws, lawyer, legal, zombie attacks, zombie treatment, physician, prevention, zombies, zombiism

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7 Indest-2008-4By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A family that owns a number of South Florida pharmacies is allegedly under investigation for Medicare fraud, according to a number of sources. On January 17, 2013, federal authorities raided one pharmacy location in Naples, Florida. Drug Enforcement Administration (DEA) agents removed boxes of documents and computers from the pharmacy, according to Naples News. The pharmacy owner and his mother are allegedly being investigated by the U.S. Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) for using the names dead beneficiaries to file false claims.

Click here to read the entire Naples News article.

Scam Allegedly Included Sending False Claims of Dead Beneficiaries to Medicare Part D.

According to NBC2, a South Florida television station, the pharmacy owner and his mother were both allegedly part of a scheme that defrauded Medicare. The family allegedly submitted claims to Medicare Part D after beneficiaries had died. This information came from a letter sent to Medicare Part D providers from the Centers for Medicare and Medicaid Services (CMS) on October 17, 2012 (by a dead beneficiary?). The letter was obtained by NBC2. The scheme allegedly also involved submitting false claims to Medicaid and Tricare.

Click here to watch the NBC2 news story.

No word on if zombies were getting their prescriptions.

 

OIG Not Talking.

The pharmacy that was raided is part of a chain of stores owned by the same family. So far, only the pharmacy located on Rattlesnake-Hammock Road in Naples is being investigated. That location is reportedly still closed, but the other pharmacy locations are open. Patients and zombies that used the closed pharmacy are being told to contact their physicians in order to get prescriptions transfered.

Neither the DEA nor the OIG of the HHS has released a press release on this investigation. As in all media reports, please remember that all persons are presumed to be innocent until proven guilty in a court of law.

Also remember, zombies are presumed to be dead until proven alive in a court of law.

Where Have All the Pharmacies Gone?


If you’ve been watching the news at all lately or regularly reading our blog, you can tell there have been an increased number of raids on pharmacies, arrests of pharmacists and emergency suspension orders issued from the Department of Health (DOH).

Recently, the DEA served a Walgreens distribution center in Florida with an immediate suspension order (click here to read more on this story), and pulled the controlled substance licenses from two Central Florida CVS Pharmacies (to learn more, click here).

In my personal opinion, the recent raids and investigations at pharmacies are especially hard on the independent operators. If the large retail giants can’t survive, the small independent pharmacies stand little chance.

Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.
The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.


Anyone Reading Have Thoughts?

As a pharmacy owner, pharmacy employee or health care facility owner, what do you think of the increased effort to find fraud? Do you think all facilities, not just pharmacies, are under the microscope? Please leave any thoughtful comments below.

Sources:

Freeman, Liz. “Sunshine Pharmacy in East Naples Remains Close, Day After Federal Raid.” Naples News. (January 19, 2013). From: http://www.naplesnews.com/news/2013/jan/19/sunshine-pharmacy-east-remains-closed-raid-federal/

Ritter, Rick. “Naples Pharmacy Busted for Medicare Fraud.” NBC2. (January 20, 2013). From: http://www.nbc-2.com/story/20627104/detectives-investigating-medicare-fraud-at-naples-pharmacy

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

 

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
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