Senator Roberts Introduces Bill to Improve Rural Health Care


U.S. Senator Pat Roberts (R-Kan.), co-Chairman of the Senate Rural Health Care Caucus, said his legislation to improve rural health care will strengthen the rural health delivery system and provide relief to hospitals and other providers serving rural Americans.

Senator Roberts, and Senators Al Franken (D-MN), John Barrasso (R-Wyo.) and Health Education Labor and Pensions Committee Chairman Tom Harkin (D-Iowa) have introduced S. 2359, the Craig Thomas Rural Hospital and Provider Equity Act (R-HoPE) to honor the service of the late Sen. Craig Thomas (R-Wyo.). You can read a summary of the bill here and download a copy of the bill here.

“The R-HoPE Act recognizes that rural health care providers have very different needs than their urban counterparts and that health care is not one-size-fits-all,” said Roberts, co-chair of the Senate Rural Health Caucus. “I am glad we were able to include provisions to get rid of Medicare’s ‘condition of payment’ known as the burdensome 96-hour rule, which is particularly troubling for critical access hospitals and in turn, their patients.”

The bill makes changes to Medicare regulations for rural hospitals and providers, recognizing the difficulty in achieving the same economies of scale as large urban facilities. It also equalizes Medicare=s disproportionate share hospital payments to bring rural hospitals in line with urban facilities and provides additional assistance for small, rural hospitals that have a low-volume of patients. Often, these hospitals have trouble making ends meet under the Medicare payment system.

OIG report reflects increase in EHR oversight


The Department of Health and Human Services Office of Inspector General is making good on its promise to increase its focus on determining whether electronic health record use leads to Medicare fraud and abuse.

In its semi-annual report to Congress, released May 27, OIG highlights several new initiatives regarding EHRs, including identifying vulnerabilities in the Centers for Medicare & Medicaid Services’ oversight of its contractors. OIG found that CMS had provided the contractors with only limited guidance on EHR fraud and raised concerns that the contractors could not identify copied and over documented information in an EHR. The agency also found that only one-quarter of hospitals studied had policies on the use of the EHR copy-and-paste feature to reduce the risk of billing fraud.

OIG reported on its recommendations regarding its findings, including that “HHS should ensure that audit logs are operational whenever EHR technology is available for updates or viewing.

“ONC and CMS should strengthen their collaborative efforts to develop a comprehensive plan to address fraud vulnerabilities in EHRs,” the report continued. “[W]e recommend that CMS develop guidance on the use of the copy-paste feature in EHR technology.”

OIG reported more than $3.1 billion in expected recoveries from its program integrity efforts, including $395 million in audit receivables and $2.83 billion in investigative receivables. It also brought 465 criminal and 266 civil actions in the past six months.

Ky. hospital to pay nearly $41M to settle kickback, false claims charges

From Modernhealthcare:

King’s Daughters Medical Center has finalized a settlement with the U.S. Justice Department that resolves allegations that it performed unnecessary cardiac procedures and had inappropriate financial relationships with referring physicians.

The Ashland, Ky.-based hospital, the largest in the state, had disclosed in its 2013 annual report that it was in negotiations for the $40.9 million settlement.

The Justice Department alleged that between 2006 and 2010, King’s Daughters billed Medicare and Medicaid for numerous unnecessary coronary stents and diagnostic catheterizations. Moreover, it claimed that physicians falsified medical records to justify the unnecessary procedures.

The settlement also covers allegations that King’s Daughters violated the Stark law by paying certain cardiologists unreasonably high salaries.

As part of the deal, King’s Daughters will enter into a five-year corporate integrity agreement with HHS’ inspector general’s office that requires it to overhaul its internal compliance program and commit to third-party review of claims it submits to federal healthcare programs.

The hospital is one of a number of providers to come under scrutiny for alleged overuse of profitable stent surgeries. The government has taken the position that a coronary artery must be at least 70% blocked to justify a stent.