First Healthcare Compliance CONNECT- April 2018

®
CONNECT
An Exclusive Monthly Publication for Clients
7
Fast Facts
about the
False Claims Act
April 2018
Ride Sharing
Companies: Your
New BAs
EEOC
Roundup
Are you a
Compliance
Super Ninja?

Important Compliance Dates
February April
1
April 1, 2018 begins the transition period for claim submissions with
new Medicare Cards. Cards will be mailed to beneficiaries April
2018-2019.
April
30
February July
1
Section 1904.32(b)(6) requires the OSHA Form 300A (Annual
Summary) be posted no later than February 1 of the year following
the year covered by the records and keep the posting in place until
April 30, 2018.
The date by which certain employers are required to submit to OSHA
the information from their completed 2017 Form 300A is July 1,
2018.
October
1
The Model Performance Period for BPCI Advanced starts on October
1, 2018, and runs through December 31, 2023.
Each month we highlight one exceptional compliance
professional chosen by our client services team. If our team
notices your compliance chops, you might be the next Ninja!
In This Issue:
Important Compliance Dates
Compliance Super Ninja
7 Fast Facts about the False Claims Act
Patient Safety Gaps
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Compliance Super Ninja
Nina Backes
Practice Manager
Nanticoke Surgical Associates
How would you describe your experience with First Healthcare Compliance?
My experience with First Healthcare Compliance has been so great. We started with your organization I believe
4 or 5 years ago when I was trying to navigate through the red tape of compliance and HIPAA. Your organization
with the dashboard set up was user friendly and saves me a tremendous amount of time and energy to keep all
my compliance issues up to date. I love the fact that I receive weekly emails giving me important information
to make sure all my compliance issues are up to date and accurate without me having to do all the research to
navigate through the processes. I love the training modules and my staff and I do them and keep them up to date
and they are so helpful. I love the fact that you automatically check all employees each month to see if there are
any violations. I would have been hours upon hours trying to figure all the ins and outs of compliance without
your company doing all that for me and me just checking the boxes and doing what was necessary to make sure
our office stays compliant in all areas. It has been so helpful to me as a practice manager and has given me one
less thing to stress over because I know if my dashboard says I am okay, then I am okay and that is such peace
of mind for me.
What do you enjoy most about working with Nanticoke Surgical Associates?
I have been with Nanticoke Surgical Associates for over 15 years and practice manager
for over 3 of those years. I truly love working here. The doctors are wonderful
to work for, my staff is amazing and we all get along and work as a team each and
every day. The office is beautiful and I feel fully supported by the doctors with any
issues that come up with resources that they are more than willing to supply to me
to make running the office as stress free as possible. I am blessed to work here.
Would you rather be able to teleport anywhere or be able to read minds?
I would rather be able to be telported anywhere because I have done very little traveling
in my 57 years of life and there are many places I would like to visit. I would
not want to read people’s minds for sure!
EEOC Roundup: Cases Against Healthcare Providers
1st Talk Compliance
Ride Sharing Companies are your New HIPAA Business Associates
Upcoming Learning Opportunities
Contact Toll Free: 888-54-FIRST 3

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Get the eBook!
When a patient safety incident, medical error or adverse event occurs, patients are
rarely the only victims. Join us to explore the impact on caregivers and understand
the lasting damage to those providers.
®
Patient Safety Gaps
Medical Errors and Second Victims
Read more about:
• Background of Patient Safety Gaps
• Scope of the Problem
• Medical Errors and Accountability
By David M. Sommers MD JD LLM
Download your copy today!
Contact Toll Free: 888-54-FIRST 5

By Sheba Vine, JD, CPCO
The Equal Employment Opportunity Commission (EEOC) has been
scrutinizing the policies of healthcare providers recently. As the federal
agency responsible for enforcing federal employment discrimination
laws, healthcare providers with outdated policies and/or practices may
find themselves in hot water. Here are the some of the most recent
cases the EEOC has initiated:
EEOC v. Montrose Memorial Hospital, Inc.
EEOC sued Montrose Memorial Hospital for age discrimination because
29 employees over the age of 40 were terminated for supposed performance
deficiencies while younger employees were treated more
leniently. The EEOC alleged that hospital management made ageist
comments, including that younger nurses could “dance around the
older nurses” and that they preferred younger and “fresher” nurses.
Under the Age Discrimination in Employment Act (ADEA) it is unlawful
to discriminate against an employee or applicant because of his/her
age with respect to any term or of employment.
Montrose agreed to settle the suit for $400,000 and also agreed to
take the following actions:
• Conduct annual anti-discrimination training for its employees,
managers, supervisors and human resources employees;
• Revise and distribute its anti-discrimination policy; and
• Report complaints of age discrimination to the EEOC.
EEOC v. Memorial Healthcare
The EEOC filed suit against Memorial Healthcare for religious discrimination
because it withdrew a job offer as a medical transcriptionist due
to Plaintiff’s religious objection to receiving an influenza vaccination.
While Memorial has a policy requiring all new employees to obtain an
influenza vaccination, it also has a policy that allows the use of masks
for those who do not get vaccinated. The EEOC noted that Plaintiff
would eventually work from home and offered to wear a mask.
The EEOC claimed that Memorial’s adverse action violated Title VII
of the Civil Rights Act (Title VII) which protects employees against
discrimination based on religion and requires employers to provide
employees with reasonable accommodations to allow them to practice
their sincerely held religious beliefs. The suit is currently being litigated
in the U.S. District Court for the Eastern District of Michigan.
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EEOC v. Mission Hospital, Inc.
In another lawsuit regarding influenza policies, the EEOC
filed suit against Mission Hospital for religious discrimination.
EEOC stated that Mission requires all employees to
receive an annual influenza vaccination. Mission allows
exemptions based on religious beliefs but requires that
requests be made by a specific date- Sept. 1. The EEOC
alleged that three employees requested religious exemptions
to the vaccination requirement and were denied
because it was after the Sept. 1 deadline. As a Result,
Mission terminated all three employees.
Mission Health System agreed to settle the case in the
amount of $89,000, in addition to the following:
• Revise its immunization policy to allow employees
to request an exemption during the same period in
which flu vaccines are to be received;
• Provide annual training for management on Title VII,
including the topic of religious accommodations and
employer obligations;
• Post a notice about the lawsuit to all employees; and
• Provide the EEOC with periodic reports on requests
for religious exemption from the flu vaccination.
EEOC v. Trinity Hospital
The EEOC sued Trinity Hospital for violating Title VII
and the Americans with Disabilities Act (ADA) because
it failed to accommodate a nurse with a pregnancy-related
health condition by refusing to provide her with a
light-duty work assignment. The EEOC alleged that Trinity
provided light-duty assignments exclusively to employees
that suffered workplace injuries.
The EEOC has taken the position that under the Pregnancy
Discrimination Act of Title VII temporary light duty assignments
must be offered to pregnant employees if the same
accommodation is provided to non-pregnant employees.
Trinity agreed to a $95,000 settlement in addition to the
following:
• Revise its policies to assure compliance with Title VII
and the ADA in requiring accommodations for pregnancy-related
limitations;
• Provide training to its human resources employees
and ensure its policies are accessible to its employees;
and
• Provide the EEOC with periodic reports.
EEOC v. Pioneer Health Services, Inc.
The EEOC sued Pioneer Health Services for failing to provide
a reasonable accommodation under the ADA when
it terminated a social worker/therapist for exhausting her
leave under the Family and Medical Leave Act (FMLA).
Plaintiff was approved for FMLA leave to undergo liver
transplant surgery. Plaintiff’s request for an extension
of leave for recovery was denied because she had
exhausted her 12 weeks of leave. As a result, she was
terminated. Pioneer also refused to re-hire Plaintiff for an
available social worker/therapist position several months
later.
EEOC claimed that Pioneer failed to accommodate
Plaintiff’s disability by denying her extension of leave
request and also retaliated against her when it refused
to rehire her for an open position.
EEOC District director stated that “the intersection of the
ADA and Family and Medical Leave Act will continue to
be an area of focus for the EEOC,” Courts have ruled that
disabled employees that exhaust FMLA may be entitled
to additional leave as a reasonable accommodation under
the ADA.
Pioneer settled the case for $85,000 and agreed to the
following:
• Provide employee training on the ADA;
• Review and update its anti-discrimination policies;
• Assign a senior company official, trained on ADA,
with the responsibility of providing written recommendations
to Pioneer’s management before
terminating any employee based on his or her actual,
perceived, or record of a physical or mental impairment,
or for exhaustion of medical leave.
Learn from these healthcare employers mistakes to avoid
similar outcomes. Make sure your policies and practices
are compliant with the law.
Contact Toll Free: 888-54-FIRST 7

talk
compliance
hosted by Catherine Short
Catherine Short talks with Jennifer Gimler Brady, Partner and General Counsel at the law firm of
Potter Anderson & Corroon in Wilmington, DE about Employee Handbooks: Basics and Must-
Haves- discussing why employers of all sizes should utilize employee handbooks. They will
also talk about some key employment laws that should be addressed in handbook policies, and
some “best practice” recommendations.
Starting Monday,
April 23rd on
Listen weekdays at
7:30am, 3:30 pm, 11:30pm ET
Check out our Show Page!
Looking for the latest compliance insights?
Subscribe to our feed and don’t miss a thing!
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COMPLIANCE WORD SEARCH
Contact Toll Free: 888-54-FIRST 9

By Sheba Vine, JD, CPCO
Early this month Uber introduced the launch of Uber Health, a new service that
allows healthcare organizations to provide transportation for their patients.
Within days, Lyft and Allscripts announced a partnership to allow healthcare
providers to schedule patient rides using Allscript’s electronic health record
network. The move into Non-Emergency Medical Transportation (NEMT)
services is an effort to eliminate transportation barriers for patients—a
2005 study estimated that at least 3.6 million people miss or delay their
medical appointments each year because they lack transportation. As ridesharing
companies hail into the healthcare industry, compliance with Health
Insurance Portability and Accountability Act (HIPAA) and fraud waste and
abuse laws are essential for participating healthcare providers.
According to HIPAA, any entity that uses or discloses protected health information
(PHI) on behalf of a covered entity is defined as a Business Associate.
A covered entity must obtain satisfactory assurances from a Business
Associate that it will safeguard the PHI it receives or creates, also known as a
Business Associate Agreement (BAA). For more information read our previous
blog titled Define Your Relationship- Vendor or Business Associate.
If healthcare providers are directly providing PHI to ridesharing companies to
schedule transportation for patients, such as providing the patient name and
home address for pick up or drop off, then a business associate relationship
exists pursuant to HIPAA. As a result, healthcare providers must enter into
BAAs before these services are used for their patients.
Healthcare providers must also comply with fraud waste and abuse laws. For
instance, the Anti-Kickback Statute (AKS) prohibits the knowing and willful
payment of remuneration to induce or reward patient referrals or the generation
of business involving any item or service payable by the Federal health
care programs. Providing transportation at little or no cost can potentially
be viewed as an inducement or kickback to use the provider. And violations
under AKS can give rise to civil monetary penalties, false claims act liability,
and program exclusions.
Effective as of January 6, 2017, the Office of Inspector General issued a final
rule that added, among other things, a local transportation safe harbor to the
AKS. Specifically, the safe harbor allows healthcare providers to provide free
or discounted local transportation services for Federal health care program
beneficiaries, if the following are met:
1. The availability of the transportation services is set forth in written policy,
which is applied uniformly and consistently, and the availability of the
services is not determined in a manner related to the volume or value of
Federal health care program business;
2. The free or discounted local transportation services are not air, luxury, or
ambulance-level transportation;
3. The transportation services are not publicly marketed or advertised, no
marketing of health care items and services occurs during the course of
the transportation or at any time by drivers who provide the transportation,
and drivers or others arranging for the transportation are not paid
on a per-beneficiary-transported basis;
4. The services are only available to an established patient, which is defined
as a patient who has previously attended an appointment and includes
a patient who has scheduled an appointment.
5. The patient is within 25 miles of the health care provider to or from
which the individual is being transported, or within 50 miles if the patient
resides in a rural area;
6. Transportation services is provided for the purpose of obtaining medically
necessary items and services; and
7. The eligible entity that makes the transportation available bears the
costs of the free or discounted local transportation services and does
not shift the burden of these costs onto any Federal health care program,
other payers, or individuals.
42 C.F.R. § 1001.952(bb).
When it comes to compliance, healthcare providers need to stay vigilante as
new players enter the market.
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Contact Toll Free: 888-54-FIRST 11

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DoctorsManagement
FAQs
How often should a chart audit be
conducted?
The OIG recommends audits to be conducted periodically, but besides
this there are no specific requirements outlined by OIG or HIPAA. It is
up to each organization to develop an audit plan in order to identify
frequency of audit and what will be covered. This will vary from
organization to organization based on risk level, infrastructure, etc. We
offer a audit guidebook under Audit Zone, Resources, which provides
pertinent information on conducting audits of medical records.
Contact our Client Services Team with your questions!
888.54.FIRST or clientservices@1sthcc.com
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