Find out what’s happening in the world of federal healthcare regulations by reviewing some recent headlines from across the country.
EMTALA violations declining
The number of U.S. hospitals cited for violating the Emergency Medical Treatment and Active Labor Act (EMTALA) has decreased over a 10-year period, according to a study published in the Annals of Emergency Medicine. Researchers analyzed a list from CMS of EMTALA investigations conducted from 2005?2014 and found that the percentage of U.S. hospitals cited for violations citations decreased from 5.3% to 3.2%. The percentage of hospitals investigated also declined during this period from 10.8% to 7.2%.
EMTALA aims to prevent the practice of discharging or transferring patients to other hospitals before stabilizing treatment is provided for emergency medical conditions. It requires hospital emergency departments to provide medical screening examinations to patients seeking medical treatment regardless of their ability to pay, citizenship, or legal status.
Stark Law, EMTALA violation penalty amounts increase
Due to several years of inflation, the U.S. Department of Health and Human Services recently issued an interim final rule that calls for steeper maximum penalties for violating federal regulations, including EMTALA and the Stark Law.
For hospitals with more than 100 beds, the maximum penalty for an EMTALA violation is $ 103,139, up from the previous maximum of $ 50,000 set in 1987. For hospitals with less than 100 beds, the maximum penalty is $ 51,570, up from $ 25,000.
Circumventing the Stark Law’s self-referral restriction can now result in a maximum penalty of more than $ 159,000, up from previous maximum of $ 100,000 set in 1994. Submitting claims in violation of the Stark Law can result in a penalty of nearly $ 24,000, up from $ 15,000.
Home health agency owner sentenced for healthcare fraud, kickbacks
Khaled Elbeblawy, the former owner and manager of three home health agencies in the Miami area, will spend 20 years in prison for his role in a scheme that fraudulently billed Medicare for millions of dollars.
Elbeblawy was sentenced to prison and ordered to pay more than $ 36 million in restitutions following his conviction in January of one count of conspiracy to commit healthcare fraud and wire fraud and one count of conspiracy to defraud the United States and pay healthcare kickbacks. According to evidence presented at trial, from 2006?2013, Elbeblawy and his co-conspirators claimed to have provided medically necessary home health services to Medicare beneficiaries through the three agencies: Willsand Home Health Agency Inc., JEM Home Health Care LLC, and Healthy Choice Home Services Inc. In reality, those services were either medically unnecessary or never provided. The conspirators also paid kickbacks to physicians, patient recruiters, and staffing groups for referrals of beneficiaries.
In all, Elbeblawy and his co-conspirators submitted $ 57 million in false or fraudulent claims and received approximately $ 40 million in payments. In 2012, Eulises Escalona, a former owner of Willsand and JEM, pled guilty to one count of conspiracy to commit healthcare fraud and was sentenced to 10 years in prison. Cynthia Vilches, former co-owner of Healthy Choice, also pled guilty to one count of conspiracy to commit healthcare fraud and is awaiting sentencing.
Healthcare systems calls for dismissal of antitrust lawsuit
Carolinas HealthCare System (CHS) has argued that the joint antitrust lawsuit filed against it by the U.S. Justice Department and the North Carolina Attorney General’s office has no basis. According to the Charlotte Observer, the lawsuit alleges CHS uses its size to drive up prices to prevent competition. CHS operates 10 hospitals in the Charlotte area. Its closest competitor, Novant Health, operates five.
The lawsuit alleges CHS uses its clout to encourage health insurers to steer patients away from other lower-priced hospitals and toward CHS hospitals.
In asking for a dismissal, CHS has said the lawsuit has failed to allege any actual competitive harm to the marketplace.