| Title:
Mitigating the Possibility of Violating Professional Courtesy and Patient Discount Laws
Presenter: Rachel Rose, JD, MBA
Time: 58.42 minutes
Description: Waiver of copays, lack of documentation, and providing professional courtesies that are not legal may result in a non-clean claim, and, in turn, liability under the FCA. Rachel Rose, Attorney at Law, wraps up this discussion and highlights how to mitigate risk and maintain legal compliance with a substantive compliance program.
Objectives: -
Review related items.
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Understand what constitutes an adequate compliance program.
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Define professional courtesy.
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Discuss patient discount laws.
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Explore the emerging role of AI in billing-trust but verify.
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Conclude with comments on compliance and mitigating risk.
Key Topics: -
Related Items Review
• Clean Claims
• Copay Versus Deductible
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Implementing and Maintaining a Formal Compliance Program
• 65 Fed. Reg. 59434 (Oct. 5, 2000)
• Compliance Programs in Healthcare
• HHS-OIG Guidance 2023
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Professional Courtesy
• 65 Fed. Reg. 59434, 59447 (Oct. 5, 2000)
• OIG Special Bulletin August 2002
• Professional Courtesy and Stark Law
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Patient Discount Laws
• Federal Register - No Surprises Act
• Discount Health Plans
• IL - Health Facilities and Regulation (210 ILCS 89/) Hospital
• Uninsured Patient Discount Act
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The False Claims Act
• Recent FCA Data
• What Is a Claim?
• Liability for Certain Acts
• February 2024 - Lincare Settlement
• October 2016 - Hudson Valley Associates, R.L.L.P. Settlement
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How AI Comes Into Play
• How Generative AI May Come Into Play
• Google's Gemini AI Vulnerable to Content Manipulation
• NIST Definition(s) of Artificial Intelligence
• NIST Definition of Algorithm
• Blueprint for an AI Bill of Rights
• NIST
• AI-The Good
• AI-The Bad
• AI-The Ugly
• CMS and HHS-Leveraging AI
• Trustworthy Practices Can Help Agencies Achieve Mission Success With AI by Protecting Against Four Key Risks...
• October 30, 2023 - Executive Order
• March 28, 2024 - Executive Order
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Conclusion
• The Wrap-Up
Speaker Rachel V. Rose, JD, MBA - Principal. https://www.rvrose.com/ Ms. Rose has a unique background. Throughout her career, she has accumulated knowledge in a multitude of fields, with an emphasis on various facets of healthcare. Her experiences include: - working on Wall Street and at one of the "Big Four" consulting firms;
- producing for the Chairman of the Reform and Oversight Committee on Capitol Hill;
- interning at the Department of Health and Human Services;
- compiling policy papers at the Royal College of Nursing in London;
- consultative work as a top performing representative for the pharmaceutical and medical device industry;
- clerking for the Honorable Linda R. Allan (6th Judicial Circuit, FL).
Prior to opening her law firm, she was Director of Business Development and Assistant General Counsel for a healthcare advisory company. She is extensively published and presents on a variety of healthcare, False Claims Act and securities law topics including: cybersecurity, qui tam, physician reimbursement, ICD-10, access to care, anti-kickback and Stark laws, U.S. Supreme Court cases impacting the medical device industry, international comparative healthcare laws, and the HIPAA/the HITECH Act.
Presently, she is the immediate past-chair of the Federal Bar Association's Corporate and Associations Counsel Division (2014-2016), one of eighteen lawyers, who serves on the Federal Bar Association's Government Relations Committee. Ms. Rose has co-authored The American Bar Association's books - The ABCs of ACOs and What Are International HIPAA Considerations?, as well as being a co-editor of American Health Lawyers Association’s Enterprise Risk Management Handbook (2nd Edition). Ms. Rose is also an Affiliated Member of the Baylor College of Medicine's Center for Health Policy and Medical Ethics, where she teaches bioethics and is on the University of Houston Law School's Healthcare Law Advisory Board.
Education - Bachelor of Arts- History (The Pennsylvania State University)
- Master of Business Administration (Vanderbilt University)
- Doctorate of Jurisprudence (Stetson University College of Law); Editor, The Journal of International Law and Aging
Honors and Awards - National Scribes Award
- The William F. Blews Pro Bono Service Award
- Federal Bar Association Fellow
- Named to Texas Bar College
- National Women Trial Lawyers Association - Top 25,, 2018 and 2019
- Houstonia Magazine's Top Lawyers- Healthcare Law, 2018 and 2019
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