Department of Health and Human Services Announces Mental Health Parity Final Rule

Lance Leider_smBy Lance O. Leider, J.D., The Health Law Firm

On November 8, 2013, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced the promulgation of the agency’s final rule related to parity of coverage of mental health and substance use treatment. According to Sebelius: “For way too long, the healthcare system has openly discriminated against Americans with behavioral health problems.”

The purpose of the regulations is to close the gaps in coverage that permit insurance carriers to treat mental and substance-abuse related treatment different from traditional medical and surgical benefits.

Among the key provisions of the regulations are the elimination of separate mental health deductibles, co-insurance, etc.; elimination of limits on lifetime benefits; as well as several other measures insuring that mental health benefits are treated on par with traditional medical and surgical benefits.

Compliance with the final rule will be required by group health plans and health insurance issuers offering group health insurance coverage on the first day of the first plan year beginning on or after July 1, 2014.

Click here to read the press release from the HHS.

Effects on Healthcare Providers.

From a business perspective, this final rule may change the type of coverage that is required to be offered by a practice to its employees. Likewise, employed practitioners may see changes in the way the coverage offered by their employers works.

Also, these rules may allow primary care providers to significantly limit their exposure to civil and administrative complaints resulting from the provision of basic mental health services. Often times patients who are unable to afford mental health coverage rely on their primary care physician for assistance. This sometimes leads to primary care doctors prescribing and managing medication for which they are inadequately trained or otherwise uncomfortable with.

By ensuring parity in coverage, primary care physicians should be able to make referrals to mental health providers with confidence that their patients will not face any artificial barriers to coverage.

Additionally, mental health providers will likely see an increase in patient volume and utilization. These increases will likely come from additional referrals from physicians as well as increased self-referrals from patients seeking to take advantage of their coverage.

Finally, with increased utilization comes increased revenue, and with increased revenue comes increased scrutiny. Private insurers have undertaken an auditing protocol that is remarkably similar to that of federal payors like Medicare, Medicaid, TRICARE, etc.

Considering the abuses that have been publicized in the mental health sector and the increased scrutiny coming from federal and state governments, we expect mental health providers will receive the same or similar audit treatment from private payors.

Be Prepared for Possible Change in Mental Healthcare Field.

Should the Affordable Care Act (ACA) ultimately serve to dramatically increase the number of Americans with insurance coverage, mental health providers may find themselves at the forefront of a rapidly expanding part of the healthcare field.

Be prepared for these changes by reviewing your processes and documentation. Consult with an experienced healthcare attorney or other similarly qualified expert to make sure your practice is ready.

The Health Law Firm Supports the Mental Health Parity Rule.

The Health Law Firm fully supports the Mental Health Parity Rule. The provision of mental health services for our citizens is long overdue.

Many fail to recognize the costs paid by our society to deal with those who have mental health issues outside of the healthcare system. Jails and prisons are often the final repository for those who should receive hospital treatment. Many individuals who are homeless, who are veterans, or who have serious mental health issues could lead constructive, productive lives if they receive proper mental health treatment.

Psychologists, psychiatrists, mental health counselors and social workers should be happy for the adoption of the regulation. In addition, law enforcement officials, judges and relatives of those with mental illness must also be thankful.

Contact Health Law Attorneys Experienced in the Representation of Mental Health Counselors, Psychologists, Social Workers, and Marital and Family Therapists.

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, psychiatrists, social workers and family therapists in Department of Health (DOH) investigations, business transactions, contracts, structuring business ventures, clinical privileges actions, professional licensure matters, Board hearings, business litigation, Medicare and Medicaid audits, and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Were you familiar with the final mental health and substance use disorder parity rule? How do you think it will affect the mental healthcare field? Please leave any thoughtful comments below.

Source:

U.S. Department of Health and Human Services Press Office. “Administration Issues Final Mental Health and Substance Use Disorder Parity Rule.” U.S. Department of Health and Humans Services. (November 8, 2013). From: http://www.hhs.gov/news/press/2013pres/11/20131108b.html

About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

 

 “The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

New Mexico’s Largest Mental Health Providers Accused of Defrauding Medicaid Out of $36 Million

10 Indest-2008-7By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

For months now, 15 New Mexico behavioral health agencies have been the subject of a Medicaid fraud investigation. The state’s largest mental health providers had their Medicaid funding frozen by the New Mexico Human Services Department (HSD) due to credible allegations of fraud, according to KUNM News. The behavioral health agencies are accused of collectively defrauding Medicaid of $36 million over three years. The findings in an audit conducted in 2012, by OptumHealth, the contractor that handles Medicaid payments for New Mexico’s behavioral health system, alarmed state officials to the point that they hired Public Consulting Group (PCG), a firm that specializes in Medicaid fraud, to conduct another audit in June 2013.

These behavioral health agencies provided services to approximately 30,000 patients. According to KUNM News, Arizona companies have been hired to step in to help patients needing treatment.

Click here to read the KUNM News article.

Audits and Whistleblower Claims Uncover Serious Accusations.

The reason for the Medicaid funding freeze, according to the HSD, was the initial audit conducted by OptumHealth, the company that manages Medicaid dollars for New Mexico’s behavioral health agencies. OptumHealth allegedly found problems with billing by the agencies in question. Then a second audit by PCG allegedly uncovered widespread overpayments for services that had never been provided. According to the New York Times, a quarter of patients’ claims were processed with mistakes.

During the PCG audit, whistleblowers also came forward with their own accusations, according to the New York Times. In one case, an employee was allegedly ordered not to inform the state that a patient had died. In another, an ex-employee at an agency reported being fired after refusing to overbill for services.

Click here to read the entire New York Times article.

To learn more on whistleblower cases, read our two-part blog. Click here for part one, and click here for part two.

Mental Health Providers Fight for Funding.

New Mexico officials state that they were obligated under federal law. Under the Affordable Care Act, states have more power to suspend payments when there is credible evidence that Medicaid dollars are being misused. All 15 mental health providers sought exceptions from the state so their Medicaid funding could be restored while the investigation continues. Only three exceptions were granted, according to the New York Times.

Mounting Pressure to Root Out Medicare and Medicaid Fraud.

Just this year, we’ve noticed the government become more aggressive in its anti-fraud and recovery efforts. The Affordable Care Act also gives investigators and prosecutors new tools to crack down on abuse. Now that the government is collecting more money, you can expect their efforts to get worse.

Since whistleblowers stand to receive up to thirty-five percent (35%) of a recovery made by the government, plus attorney’s fees and costs, you can expect more whistleblower lawsuits to be filed. Therefore, it is now more important than ever to verify accurate billing and coding.

Most Qui Tams Filed by Doctors, Nurses and Employees.

From our review of qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.

Sources:

Frosch, Dan. “Fraud Investigation Unsettles Mental Health Care in New Mexico.” New York Times. (September 16, 2013). From: http://www.nytimes.com/2013/09/14/us/fraud-investigation-unsettles-mental-health-care-in-new-mexico.html?pagewanted=all&_r=0

Ahtone, Tristan. “A Timeline of NM’s Shakeup of Behavioral Health Providers.” New Mexico In Depth. (September 13, 2013). From: http://www.nmindepth.com/2013/09/13/a-timeline-of-nms-shakeup-of-behavioral-health-providers/#

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999. Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Central Florida Mental Health Counselor Accused of Heading Up $3 Million Medicaid Fraud Scheme

GFI Blog LabelBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Michael L. Smith, J.D., R.R.T., Board Certified by The Florida Bar in Health Law

A registered mental-health counselor is accused of running a $3 million Medicaid scheme through the mental health facility she owned, according to the Florida Office of the Attorney General (AG). On March 27, 2013, the facility owner was arrested. She faces charges of racketeering, Medicaid fraud and identity theft. According to the AG, local, state and federal law enforcement officers were all involved in the investigation.

Click here to read the press release from the AG.

Mental Health Counselor Reportedly Billed Medicaid for Services Never Rendered.

According to the Orlando Sentinel, between 2012 and 2013, the mental health counselor billed Medicaid more than $3 million for services provided to Medicaid recipients with mental health needs that were never rendered. The facility owner is also accused of using gift cards to bribe people into letting her use their Medicaid numbers and service applications. Click here to read the entire article from the Orlando Sentinel.

Money was Used on Luxury Items.

Authorities said the mental health counselor allegedly used the money to buy a cruise trip for seven people, a trip to Mexico, jewelry and more than $175 worth of Louis Vuitton products. Agents allegedly searched the mental health counselor’s home and business. They apparently seized a Cadillac Escalade and a Ducati Superbike from her home, according to the AG.

The mental health facility owner is charged with one count of second-degree Medicaid fraud, one count of first-degree racketeering, and one count of second-degree identity theft.


Medicare and Medicaid Investigations and Audits of Psychologists and Other Mental Health Professionals.

Over the past year we have observed an increasing number of Medicare and Medicaid investigations and audits being initiated against all mental health professionals. We have also seen a number of investigations and audits initiated against psychologists and mental health professionals who treat assisted living facility (ALF) and skilled nursing facility (SNF) residents. There is a two-part blog on our website on this topic. Click here for part one, and click here for part two.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Comments?

Do you think there is an increase in investigations on mental health care providers? Please leave any thoughtful comments below.

Sources:

Meale, Jenn. “Medicaid Fraud Control Unit and Partners Arrest Ringleader of $3 Million Medicaid Fraud Scheme.” Office of the Attorney General. (March 27, 2013). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/283E6646009F8B9685257B3B00664A79

Pavuk, Amy. “Bondi: Orlando Woman Ran $3M Medicaid Fraud Scheme.” Orlando Sentinel. (March 27, 2013). From: http://www.orlandosentinel.com/news/local/breakingnews/os-medicaid-fraud-investigation-20130327,0,2857142.story

About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Michael L. Smith, J.D., R.R.T., is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999. 

Copyright © 1996-2012 The Health Law Firm. All rights reserved.