If you are a health care provider, you are obligated to understand the programs, rules and regulations. In fact, if you review the application you or your company signed for Medicare, Medi-Cal or Medicaid, or a private insurance company you will see language indicating that you agree to follow the rules and regulations of these programs. While these programs can be complicated and an experienced health care lawyer can greatly assist you in complying with these rules, you will be a better provider and a better client the more you and your office are informed and understand the rules and business trends you are facing in health care. This is a fairly comprehensive list of websites that a health care provider can use as a starting point.
As longtime attorneys representing professionals, especially health care providers, we find that it is easier to represent those that are educated and sophisticated about their business and we do our best to educate our clients during the course of our representation. It is much easier to prevent problems than to solve them and education is part of that process. Please feel free to email us if you have any suggestions for websites you think would be helpful to others.
GENERAL BUSINESS OF HEALTH CARE
The health care industry is approximately 12% of the U.S. gross domestic product (GDP) and is a constantly changing business. It is helpful to keep informed of market and business changes since it can ultimately help you stay ahead of the business curve and regulatory trends.
Modern Healthcare (free registration required) A health care business newsletter to keep you informed of recent developments. http://www.modernhealthcare.com/
Modern Physician (free registration required) An e-mail newsletter for "physician executives, leaders and entrepreneurs." http://www.modernphysician.com/
OFFICIAL FEDERAL GOVERNMENT WEBSITES
The government rules, regulations and manuals are online. It takes some research but health care providers must stay informed. An experienced health care attorney can be of great help to keep you understand these complicated rules and remain compliant but the more you know, the easier it will be for you and your office to stay compliant, understand the rules and regulations, minimize your risk for overpayments and other issues and keep your legal bills lower.
U.S. Department of Health & Human Services http://www.hhs.gov/
CMS (Centers for Medicare & Medicaid Services) http://www.cms.hhs.gov/
CMS was formerly known as the Health Care Financing Administration (HCFA). CMS is the federal agency responsible for administering the Medicare, Medicaid, SCHIP (State Children's Health Insurance), HIPAA (Health Insurance Portability and Accountability Act), CLIA (Clinical Laboratory Improvement Amendments), and several other health-related programs. This website has excellent explanations of programs, including MMA, with its provision for Medicare-approved drug discount cards.
HIPAA Educational Materials for Providers
http://www.cms.hhs.gov/EducationMaterials/02_HIPAAMaterials.asp#TopOfPage
The Health Insurance & Portability Act of 1996 (HIPAA) with a series of downloadable papers covering a number of issues. These papers provide information for frequently asked questions regarding the applicability of HIPAA to health care providers' offices and are instructive.
Medicare Internet Manuals http://www.cms.hhs.gov/manuals/
The CMS online system has links to day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. They are used by CMS program components, contractors, and State survey agencies to administer CMS programs. For many others, they are a good source of technical and professional information about the Medicare and Medicaid programs. You can rely on this information and print out any information on which you rely for billing or compliance action.
CMS manuals underwent a transformation from paper to electronic. As CMS updated the manual instructions, they move the updated material into the new Internet-only manuals and eliminated the corresponding material from the outgoing old paper-based manuals. CMS will continue this phase-out/phase-in process until all manual instructions are included in the Internet-only manuals. In the meantime, you should check both sets of manuals for current policy and procedures. The paper manuals are useful for reference as well.
Official Medicare Website for your patients with Medicare: http://www.medicare.gov/
This particular website is meant for patients, but you can use information from this site to help your patients (and government regulators/auditors) understand the program benefits. This has good forms you can give to your patients. Providers are better advised to use the CMS website.
Office of Inspector General (Division of Department of Health and Human Services) http://oig.hhs.gov/index.asp
The mission of the Office of Inspector General (OIG) is to protect the integrity of Department of Health and Human Services (HHS) programs, as well as the health and welfare of the beneficiaries of those programs. The OIG has a responsibility to report both to the Secretary and to the Congress program and management problems and recommendations to correct them. The OIG's duties are carried out through a nationwide network of audits, investigations, inspections and other mission-related functions performed by OIG components. The website has fraud alerts, advisory opinions, information about the exclusion program and other useful information. The Advisory Opinions contain valuable information regarding the anti-kickback statute in particular. The following links are useful:
OIG Advisory Opinions: http://oig.hhs.gov/fraud/advisoryopinions.asp
OIG Safe Harbor Regulations: http://oig.hhs.gov/fraud/safeharborregulations.asp
OIG Corporate Integrity/Compliance Agreements: http://oig.hhs.gov/fraud/cias.asp
U.S. Social Security Administration Homepage: http://www.socialsecurity.gov/
OFFICIAL STATE GOVERNMENT WEBSITES
Department of Health Care Services: http://www.dhcs.ca.gov/Pages/default.apx
Medi-Cal Home Site: http://www.medi-cal.ca.gov/
Medi-Cal Publications and Provider Manuals: http://files.medi-cal.ca.gov/pubsdoco/manuals_menu.asp
Bureau of Medi-Cal Fraud and Elder Abuse: http://caag.state.ca.us/bmfea/index.htm
California Medical Board: http://www.medbd.ca.gov/
LEGAL RESEARCH LINKS--STATUTES, REGULATIONS & RULES
When you are reviewing Medicare and Medi-Cal letters, you will see references to statutes and regulations. These sites will help you find these references for you to review with your legal counsel:
Search the United States Code: http://uscode.house.gov/search/criteria.shtml
Search the Code of Federal Regulations: http://www.access.gpo.gov/nara/cfr/cfr-table-search.html
Search the California Code of Regulations: http://ccr.oal.ca.gov/
OFFICIAL LISTS OF EXCLUDED PROVIDERS
If you bill Medicare and Medi-Cal and are hiring someone as an employee, independent contractor or doing business with them in any capacity, it is very important to determine whether they have been excluded by the Office of Inspector General or Medi-Cal. Save your searches and ask outside counsel or compliance officer to conduct the search and save the research. If you bill for services rendered by an excluded individual or entity, you can face overpayment issues or other administrative or criminal sanctions. With Medi-Cal, the website is not searchable by name and only lists those who have a permanent exclusion or procedure code limitation. Those Medi-Cal providers with "temporary suspensions" are not listed. Ask those providers specifically in writing if they are subject to "temporary suspension." The sites usually allow you to do a search by individual and entity names:
DHHS Office of the Inspector General: http://exclusions.oig.hhs.gov/search.aspx
General Services Administration (GSA) Excluded Parties List System. This site gives exclusion lists for numerous government agencies. This may be another way of ensuring that the business entity or person you are dealing with has not been excluded by another government agency (before they have gone into health care): http://epls.arnet.gov/
Medi-Cal Suspended & Ineligible List: http://files.medi-cal.ca.gov/pubsdoco/manual/man_query.asp?wSearch=%28%23filename+%2A%5F%2Az03%2A%2E%2A%29&wFLogo=Suspended+and+Ineligible+Provider+List&wFLogoH=32&wFLogoW=418&wAlt=Suspended+and+Ineligible+Provider+List&wPath=pubsdoco%2Fpublications%2Fmasters%2DMTP%2FzOnlineOnly%2Fsusp100%2D49%5Fz03%2F
Medi-Cal List Of Procedure Code Limitation List: http://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/zOnlineOnly/pdcl/pdcl_home.asp
MEDICAL RESEARCH ON-LINE FROM THE NATIONAL LIBRARY OF MEDICINE
PubMed is a service o fthe U.S. National Library for Physicians. These articles are often useful for showing medical necessity and explaining procedures to auditors and government regulators. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
MEDLINEplus® for authoritative consumer health information is another resource: http://medlineplus.gov/
ORGANIZATION WEBSITES WITH INFORMATIVE CONTENT
American Association of Homes and Services for the Aging. This association for nonprofit providers of housing and healthcare services for the elderly provides a lot of information for providers, consumers and family caregivers: http://www2.aahsa.org/
American Health Care Association site contains information on long-term care: with consumer guides, resources for caregivers, issue papers, links to U.S. Government reports and databases, and more: http://www.ahcancal.org/Pages/Default.aspx
American Health Lawyers Association is an excellent site with informative and free content, including bulletins of new regulatory developments and key court decisions, often with links to full text on public websites: http://www.healthlawyers.org/Pages/Default.aspx
American Medical Association: http://www.ama-assn.org/
PUBLIC RECORD SEARCHES FOR BACKGROUND CHECKS AND COLLECTIONS
We advise clients to do background checks on potential employees, business partners and other contractors to ensure that you are dealing with honest individuals without an adverse background that could cause problems for your business. Physicians and health care providers are often the victim of embezzlement and fraud because they are busy and delegate significant responsibility to office personnel. You can ask your health care attorney to refer you to a reputable private investigator which is what we do since our investigators provide understandable reports for our clients. You initially can use a public record internet company for basic background checks and then ask the investigator to follow up.
Merlindata: http://www.merlindata.com/
SearchAmerica is a useful site for locating persons and tracing for collections. They also specialize in assisting in health care collections. : http://www.searchamerica.com/
Search your local court directories to see if the contractors, providers or employees have had prior lawsuits that could affect your business. For example, in Los Angeles County, where our office is located you can the Superior Court database for a fee: http://www.lasuperiorcourt.org/
OTHER RESEARCH LINKS
Findlaw Internet Legal Resources http://www.findlaw.com/
Martindale-Hubbell - Resource on legal profession http://www.martindale.com/
OTHER HELPFUL WEBSITES
Official website of Foley and Lardner LLP, a national law firm specializing in health care law. Site has links to their health care newsletters and articles: http://www.foley.com/
Official website of McDermott, Will & Emery, a national law firm specializing in health care law. Site has links to their health care newsletters and articles: http://www.mwe.com/
Website for senior citizens includes information on nursing homes, updated articles on Medicare and Medicaid programs, in addition to relevant legal changes in those programs: http://www.therubins.com/
CONCLUSION
The Internet is a great place to become educated about health care law, rules and regulations. Having an experienced health care attorney to help ensure that you and your office follow these rules, establish proper protocols and is available when questions arise during the course of business is sound business practice. Once you and your office are better educated it helps you understand why sound risk management includes having a health care lawyer on your team.
Posted by Tracy Green, Esq. The firm focuses its practice on the representation of licensed professionals, particularly health care professionals, individuals and businesses in civil, business, administrative and criminal proceedings. You can email her at tgreen@greenassoc.com or call her at 213-233-2261. Green and Associates is located in Los Angeles, California.
The firm has a specialty in representing health care providers in health care fraud and other types of fraud and overbilling allegations in California and throughout the country. Their website is: http://www.greenassoc.com/
Any questions should be directed to Tracy Green, a very experienced Los Angeles health care attorney, Los Angeles health care fraud attorney, Los Angeles Medi-Cal attorney, Los Angeles Medicare attorney and Los Angeles physician attorney.
