Health Law Blog

On July 30, 2012, the Pennsylvania Supreme Court denied State Farm’s petition for an appeal in the case of State Farm Mutual Automobile Insurance Company, et al. v. Robert J. Cavoto, Jr., et al. (No. 943 MAL 2011).  State Farm appealed the Pennsylvania Superior Court’s decision that chiropractors can delegate certain adjunctive procedures under the Pennsylvania Chiropractic Practice Act and the Pennsylvania Motor Vehicle Financial Responsibility Law.

Adults applying for disability benefits online will now “click and sign” the SSA-827 as part of the electronic application process.  Upon execution of this process, an image of the electronically signed form immediately uploads and becomes part of SSA’s electronic disability folder for the applicant.  This eliminates the need for the applicant to print, sign, mail, or deliver a paper copy to the SSA office.  SSA is responsible for verifying the identity of the signer and protecting the information and records received. 

The American Recovery and Reinvestment Act of 2009, in Section 13411 of the HITECH Act, requires the Department of Health and Human Services (HHS) to provide for periodic audits to ensure covered entities and business associates are complying with the HIPAA Privacy and Security Rules and Breach Notification Standards.  The HHS Office for Civil Rights (OCR) is piloting a program to perform up to 150 audits of covered entities that will conclude by December 2012.

In Pennsylvania, massage therapists are now required to be licensed by the State Board of Massage Therapy.  The Massage Therapy Law (63 P.S. §§ 627.1-627.50) and the regulations set forth the guidelines and define the scope of practice for licensed massage therapists (LMT) in Pennsylvania.  The law and the regulations can be found on the PA Department of State website, and chiropractors who want to hire a massage therapist should review the new law.

Many insurers and insurance plans in Pennsylvania require covered services to be performed by an eligible professional provider (i.e. chiropractor) or performed under that provider’s supervision in accordance with the licensure, certification and/or employment criteria for reimbursement.  The Pennsylvania Chiropractic Practice Act (63 P.S. § 625.101 et seq.) allows for a licensed chiropractor to utilize the assistance of unlicensed supportive personnel performing under the direct on-premises supervision of a licensed chiropractor, so long as no activity or duty is delegated which requires the formal education or training in the practice of chiropractic or the knowledge and skill of a licensed chiropractor.  (emphasis added) 63 P.S. § 625.601.  The insurance industry attempts to avoid paying doctors of chiropractic who properly delegate adjunctive procedures to support personnel.  Adjunctive procedures are defined as “physical measures such as mechanical stimulation, heat, cold, light, air, water, electricity, sound, massage and mobilization”.  63 P.S. § 625.102.  This begs the question – which aspects of adjunctive procedures may be properly delegated to unlicensed support personnel under the Chiropractic Practice Act?

I'm pleased to announce that as general counsel to the Pennsylvania Chiropractic Association (PCA), I am spearheading a seminar to help PA chiropractors understand the issues and trends regarding audits, coding and reimbursement.  I have put together a great lineup of speakers, including David Klein, CPC, CHC, a Highmark representative from the Financial Investigations and Provider Review Department, and lawyers with expertise in Workers' Compensation and Personal Injury.  The seminar is scheduled for Saturday, November 12, 2011, and it is to be held near Harrisburg, PA.  Early signups before October 20, 2011 receive a 20% discount.  You can download the seminar brochure and registration form by clicking on the button below. 

A report recently released shows that federal health care fraud prosecutions so far this year are on pace to rise 85% over last year, according to an article appearing this week in USA Today.  This drastic increase does not come as a shock to many health care law insiders.  The federal government has made clear its objectives to ramp up anti-fraud efforts in the health care sector and to recover payments made for fraudulent claims billed to federal health care programs including Medicare and Medicaid.

The Centers for Medicare & Medicaid Services (CMS) announced that the federal government will begin employing innovative predictive technology to detect and combat Medicare fraud beginning July 1, 2011.  This initiative was made possible in part by the Affordable Care Act, which provides additional funding to ramp up anti-fraud efforts and to invest in sophisticated data analytics.

A recent article by Ricardo Alonso-Zaldivar of the Associated Press reported that federal enforcement authorities have begun targeting individual corporate executives in alleged health care fraud cases across the country.  Previously, only companies themselves were the subject of federal investigations and penalties for incidents of health care fraud.  A company found to have committed health care fraud violations could simply negotiate a settlement and pay a fine.

CMS Recovery Auditors