Living with Billeaudeau

Update: Living with Billeaudeau By: Matthew K. Brown and Isabel Bonilla-Mathé Hospitals across the state have been grappling with the ramifications of the Louisiana Supreme Court’s recent decision in Billeaudeau v. Opelousas Gen. Hosp. Auth., et al., 2016-0846 (La. 10/19/16) 218 So.3d 513. In that case, the Supreme Court upheld the decision that a claim [...]

By |2018-06-05T12:43:00+00:00June 5th, 2018|Home, News|Comments Off on Living with Billeaudeau

NEW PROCESS FOR APPEALING MEDICAID MCOS’ ADVERSE CLAIM DETERMINATIONS

House Bill 492 – New Process for Appealing Medicaid MCOs’ Adverse Claim Determinations On June 7, 2017, Louisiana House Bill 492 (HB 492) was sent to the Governor for executive approval. This Bill establishes a process for review of healthcare provider claims denied by Medicaid managed care organizations (MCOs). HB 492 will apply to the [...]

By |2017-06-16T15:29:48+00:00June 16th, 2017|Home, News|Comments Off on NEW PROCESS FOR APPEALING MEDICAID MCOS’ ADVERSE CLAIM DETERMINATIONS

Off-Campus Provider-Based Departments

Final Rules on Reimbursement for Off-Campus Provider-Based Departments By: Michael Schulze, Isabel Bonilla-Mathé On Nov. 2, 2015, Congress surprised providers with the passage of Section 603 of the Bipartisan Budget Act of 2015 (the “Act”), which eliminates Medicare Outpatient Prospective Payment System (OPPS) reimbursement for off-campus outpatient provider-based departments (off-campus PBEs) established post enactment of [...]

By |2017-04-20T15:24:50+00:00September 28th, 2016|News|Comments Off on Off-Campus Provider-Based Departments

ERISA Preemption of Claims against Managed Care Organizations

ERISA Preemption of Claims against Managed Care Organizations Based upon State Law By: Michelle K. Buford, J.D., R.H.I.A. Congress enacted the Employee Retirement Income Security Act (“ERISA”) in 1974 [29 U.S.C. § 1101, et seq.] to create and preserve national uniformity and consistency in the administration, funding and enforcement of ERISA pension and welfare [...]

By |2017-04-20T15:25:28+00:00September 25th, 2016|News|Comments Off on ERISA Preemption of Claims against Managed Care Organizations

NEGLIGENT CREDENTIALING OF PHYSICIANS

NEGLIGENT CREDENTIALING OF PHYSICIANS: INCREASED LIABILITY EXPOSURE FOR HOSPITALS EXECUTIVE SUMMARY The Louisiana Third Circuit recently held in Billeaudeau v. Opelousas General Hosp. Authority, 189 So. 3d 561 (La. App. 3d Cir. 2016) that a claim for “negligent credentialing” of a physician by a hospital does not constitute medical malpractice subject to the terms [...]

By |2017-04-20T15:26:26+00:00August 15th, 2016|News|Comments Off on NEGLIGENT CREDENTIALING OF PHYSICIANS

Medicare Outpatient Observation Notice (MOON)

Medicare Outpatient Observation Notice (MOON) … Coming Soon to a Hospital Near You On April 18, 2016, the Centers for Medicare & Medicaid Services ("CMS") released a proposed rule for implementing the Notice of Observation Treatment and Implication for Care Eligibility ("NOTICE") Act. The proposed rule requires CMS to develop a standardized form known [...]

By |2017-04-20T15:36:18+00:00August 1st, 2016|News|Comments Off on Medicare Outpatient Observation Notice (MOON)

DOJ Doubles Health Care Civil Fraud Penalties

Department of Justice Doubles Health Care Civil Fraud Penalties starting August 1, 2016 By Michael R. Schulze Sullivan Stolier Schulze & Grubb, LLC The U.S. Department of Justice (DOJ) published an interim final rule on June 30th that dramatically increased potential civil penalties under the Civil False Claims Act and the Federal Anti-Kickback Statute. [...]

By |2017-04-20T15:27:55+00:00July 28th, 2016|News|Comments Off on DOJ Doubles Health Care Civil Fraud Penalties

Desk Audits

HIPAA Desk Audits are Underway! BA Desk Audits Right Around the Corner Sullivan Stolier Schulze & Grubb LC, 7/26/2016 On July 11, 2016, HHS Office of Civil Rights (OCR) notified 167 Covered Entities (CE) of their selection, via a random sampling process, to participate in HIPAA desk audits. Desk audits will be limited in [...]

By |2017-04-20T15:28:54+00:00July 26th, 2016|News|Comments Off on Desk Audits