Kaiser Facing Two-Front Battle Against Unions, Feds

Kaiser Facing Two-Front Battle Against Unions, Feds

A union coalition for Kaiser Permanente healthcare workers reached a tentative labor deal with the hospital system on Friday that included across-the-board wage increases after 75,000 members took part in a three-day strike. Under the deal, new minimum wages will reach $25 per hour in California for union-represented employees over three years, and $23 per hour in other states where the company operates.

In somewhat related news, California investigated and found widespread issues with the delivery of mental health services, and a Kaiser Permanente subsidiary will now pay $200 million and overhaul access to care, as well as its oversight of medical groups.

Kaiser Foundation Health Plan had more than 9 million enrollees across dozens of California counties at the end of 2022. California law mandates that enrollees be offered mental health appointments within 10 business days of requests, and follow-up appointments within 10 days of those first appointments.

However, investigators reported that last year, only 44 percent of non-urgent follow-up appointments with Kaiser mental health providers were completed within the 10-day window. In 2022, non-urgent, follow-up individual appointments for behavioral health therapy were completed within an average of 18.1 business days after the prior appointment.

The Anti-Kickback Statute (AKS) makes it a crime to knowingly and willfully exchange (or offer to exchange) a gift or anything of value with the intent to gain something from the exchange. The U.S. Department of Health and Human Services (HHS) published an advisory opinion that said paying physician employees bonuses based on profits from certain procedures does not breach federal law. It is a new carve-out, created by HHS.

Whenever HHS carves out an exception to the AKS or the Stark law, I always wonder how many people were prosecuted in the past for the exact new exception. Another example is gift cards as rewards for consumers receiving substance abuse treatment; the practice has always been illegal.

However, a few years ago, HHS published an opinion that it would not prosecute behavioral health providers for doing exactly that. A caveat: don’t just present gift cards for showing up to treatment. Rewards based on clean urine drug results are fine, but only based on attendance. I thoroughly enjoyed showing Recovery Audit Contractor (RAC) auditors HHS’s advisory opinion on allowing gift cards.

The Centers for Medicare & Medicaid Services (CMS) has announced two new RAC targets. In August, CMS announced that RAC audits will review hip orthoses within the Reasonable Useful Lifetime: Excessive Units Automated. Last week, CMS announced that the RACs will investigate Hospice Care- Extended Length of Stay: Medical Necessity and Documentation Requirements.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Knicole C. Emanuel Esq.

For more than 20 years, Knicole has maintained a health care litigation practice, concentrating on Medicare and Medicaid litigation, health care regulatory compliance, administrative law and regulatory law. Knicole has tried over 2,000 administrative cases in over 30 states and has appeared before multiple states’ medical boards. She has successfully obtained federal injunctions in numerous states, which allowed health care providers to remain in business despite the state or federal laws allegations of health care fraud, abhorrent billings, and data mining. Across the country, Knicole frequently lectures on health care law, the impact of the Affordable Care Act and regulatory compliance for providers, including physicians, home health and hospice, dentists, chiropractors, hospitals and durable medical equipment providers. Knicole is partner at Nelson Mullins and a member of the RACmonitor editorial board and a popular panelist on Monitor Monday.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 SDoH Update: Navigating Coding and Screening Assessment

2024 SDoH Update: Navigating Coding and Screening Assessment

Dive deep into the world of Social Determinants of Health (SDoH) coding with our comprehensive webcast. Explore the latest OPPS codes for 2024, understand SDoH assessments, and discover effective strategies for integrating coding seamlessly into healthcare practices. Gain invaluable insights and practical knowledge to navigate the complexities of SDoH coding confidently. Join us to unlock the potential of coding in promoting holistic patient care.

May 22, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

Happy World Health Day! Our exclusive webcast, ‘2024 SDoH Update: Navigating Coding and Screening Assessment,’  is just $99 for a limited time! Use code WorldHealth24 at checkout.

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →