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HFMA – Post Acute LEGAL UPDATE SNAPSHOTS January 17, 2008

HFMA – Post Acute LEGAL UPDATE SNAPSHOTS January 17, 2008. Carol Rolf, Esq. Rolf & Goffman 350 Corporate Circle * 30100 Chagrin Blvd. Cleveland, Ohio 44124-5705 (216) 514-1100 * (216) 514-0030 Fax www.LTClawyers.com. Trends in Long Term Care. Reimbursement will continue to decline

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HFMA – Post Acute LEGAL UPDATE SNAPSHOTS January 17, 2008

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  1. HFMA – Post AcuteLEGAL UPDATE SNAPSHOTSJanuary 17, 2008 Carol Rolf, Esq. Rolf & Goffman 350 Corporate Circle * 30100 Chagrin Blvd. Cleveland, Ohio 44124-5705 (216) 514-1100 * (216) 514-0030 Fax www.LTClawyers.com

  2. Trends in Long Term Care Reimbursement will continue to decline Government as a Purchaser • Paying for outcomes, quality Advances in Technology Diversification

  3. OIG 2008 Work Plan • Consolidated Billing • Review Med B claims by suppliers Accuracy of MDS • Cases in Ohio still involve the basics – did you bill for service not delivered, personal costs on cost report, etc. • Embezzlement cases

  4. DRA and Employee Education • Effective January 1, 2007 • Entities receiving $5,000,000 in Medicaid annually • Must establish written policies for all employees, contractors and agents that provide detailed information about FCA and state false claims laws and whistleblower protections and must also be included in Employee Handbook • Policies must include detailed provisions re: entity’s policies and procedures for detecting/preventing fraud, waste, and abuse

  5. Interesting Whistleblower Case • Hefner v. Hackensack • U.S. Court of Appeals Third Circuit • July 17, 2007 • Consultant hired to help investigate hospital billing errors not a whistleblower • Billing error was caught internally and hospital returned money to Medicare voluntarily • Hospital had compliance system in place to audit coding and billing

  6. Transaction/New Development Hot Topics • Vendor withholds (including franchise fees) especially in replacement situations • CHOP, CHOW penalties for late or nonexistent notice of JFS • Making sure buyer of beds can obtain a CON • Shower variance issues, new developments • Timing of Initial surveys • Revisit fees – September 19 – December 26, 2007

  7. Arbitration in Admission and Employee Contracts • Why it makes sense • ODH developments • The importance of crafting a fair provision • Cost? • Condition of admission/employment? • Right to revoke? • Bold language? • Does facility’s insurance company recognize?

  8. New Collection/Receivable Issues • Changes in the DRA have caused collection issues • PASARR policies will also have negative impact • Early and aggressive collection is the best policy • Remember: Residents have transfer and discharge rights • Importance of understanding scope of hearing officer’s review

  9. Ancillary Contracting Issues • Remember who has the bargaining power • Employment fees • Non-compete issues • Right to terminate • Consider the RFP process. Ex. = pharmacy • Who will pay for non-covered drugs? • What do you pay – is a per diem allowed? • Will pharmacy assist in accessing best PDP for the resident?

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