Texas Health Care Law Blog

Actions that will threaten a medical career

A suspension or revocation of a medical license is one of the biggest threats to a doctor, nurse or other medical professional’s career. It may seem difficult to believe, but even after spending years striving toward their goal, many individuals in the medical field let their license be snatched away.

These are among the many behaviors that can lead to a suspension or even revocation of an individual’s license. If that happens, it is vital to speak with a legal professional immediately. An experienced attorney will know how to work within the medical field and make the strongest case possible to defend a doctor or nurse’s career.

How to prepare for a ZPIC audit

During the course of regular business, durable medical equipment (DME) providers may face audits from zone program integrity contractors (ZPICs) working under Medicare and Medicaid. These audits are meant to root out fraudulent activities. Being selected for an audit doesn’t mean your business is under suspicion, only that an impropriety has cropped up.

First, a little background. The 2003 Medicare Modernization Act created Medicare administrative contractors to oversee the plan’s administration. ZPICs were established to identify fraud, waste and abuse among Medicare Part A and Part B providers, DME prosthetics, orthotics and supplies providers, or home health and hospice providers.

Pharmacists can finally talk freely about drug prices

In the United States, where prescription drugs are not price-regulated by one, powerful agency, such as the federal government, smaller insurance companies must negotiate with these large drug makers. What the drug makers have found is, they have the upper hand. As many of us know, any drug in the U.S. costs significantly more than the same drug elsewhere.

Nothing makes the cost of prescription drugs more real than standing in front of the pharmacist when they give you the total. For that reason, it's common that pharmacists get the blame. Until recently, pharmacists were unable to even disclose cheaper alternatives to the drugs they prescribed. That has changed thanks to the bipartisan efforts of several senators. The Patients Right to Know Drug Prices Act allows pharmacists to share pricing information with customers on employer-sponsored and health care exchange plans, without penalty.

Diligence in claim filing can reduce medical audit anxiety

Who doesn't like taking shortcuts. If there is a way to get from point A to point B more easily, that's a good thing, right? That might be true in on the road, but in the health care industry, taking shortcuts around regulatory obligations can lead to financial trouble. Worse, it can result in criminal charges and result in penalties that derail careers.

Few medical practitioners intentionally follow practices that trigger investigations. However, those entities that pay claims know errors happen either by accident or on purpose, and they don't have any desire to be left holding the bag if mistakes lead to overpayments. Audits are possible and those with experience in health care law know they need to be taken seriously.

National Provider Identifiers can be stolen and used for fraud

National Provider Identifiers (NPI) are used to help streamline the medical billing process, and these 10-digit numbers function much like a social security number.

Unfortunately, like a social security number, a NPI is also vulnerable to theft. This is because NPI are not confidential and can be publicly accessed through National Plan and Provider Enumeration System, as well as by your employees and possibly through online attacks.

What the opioid epidemic could mean for your medical industry

On May 15, 2018, Texas sued Purdue Pharmaceuticals to assign blame for the thousands of opioid-related deaths throughout the state. Claiming serious misrepresentation, Attorney General Ken Paxton plans to compensate for the 42,000 opioid overdoses that occurred in 2016.

As a practitioner, your position may require increased contact with drugs like Hydrocodone and OxyContin. As Texas finds itself in the midst of an opioid crisis, you may wonder how your prescription process might change when distributing painkillers to your ailing patients.

Healthcare Investigations by the Office of Inspector General

As someone working with one or more of the over 100 Health and Human Services programs across the U.S., it’s important that you understand the body that regulates your work. Under the U.S. Department of Health and Human Services, the Office of Inspector General’s mission is to protect the integrity of department’s programs as well as the health and welfare of program beneficiaries.

What Medicare audits mean for your telehealth business

Telehealth represents an incredible step forward in medical technology. As a telehealth doctor, you represent the front line of healthcare for folks making their living in the rural parts of the country, and with that comes unique sets of challenges. More Texas-based telehealth providers than ever are being subjected to Medicare audits.

Texas Medicare fraud case highlights the need for integrity

Health care professionals are entrusted with the well-being of their patients through many services that people need when faced with poor health and medical situations. But, sometimes, even health care professionals and the executives who lead their agencies aren’t always on the straight and narrow.

A relevant and recent example relates to a federal fugitive from Texas who stole millions of dollars in a Medicare fraud scheme in which he and his associates preyed on vulnerable people such as the elderly, disabled and homeless.

Appealing a Medicare or Medicaid revocation

Medicare and Medicaid are critically important to many medical providers in Texas. Being denied the ability to bill for these patients would mean a substantial loss of income to many clinics, possibly forcing them to close. Unfortunately, the revocation of Medicare and Medicaid contracts is if anything becoming more common.

If this happens to your facility, there is a process of appealing the decision. It may be possible to have it reversed or, in some cases, even move to a corrective action settlement. Time is of the essence, however, and expertise in the somewhat arcane process is critical for success.

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