Liles Parker PLLC
(202) 298-8750 (800) 475-1906
Washington, DC | Houston, TX
San Antonio, TX | Baton Rouge, LA

We Defend Healthcare Providers Nationwide in Audits & Investigations

Health Systems Brace for Hurricane Sandy

Hurricane Sandy is Here!(October 29, 2012): Health systems across the East Coast are bracing for the effects of impeding Hurricane Sandy, set to make landfall late Monday night somewhere between Washington, D.C. and New York City. The hurricane is expected to cause devastating flooding with heavy wind and driving rain, and will ultimately leave millions of citizens without power. In addition, Hurricane Sandy could cause significant loss of life and/or injury, and safety is an utmost concern for officials in the region. In fact, the death toll from this storm has already reached 65 people, mostly in Haiti and other Caribbean islands.

 

I.  What Can Hospitals Do?

Because of the nature and predictions of this storm, hospitals, physicians, and other emergency medical personnel will likely need to be on high alert, as their skills will be relied upon heavily. Hospitals in the region have been gearing up for the storm, implementing their Emergency Preparedness plans and ensuring that access to critical facilities and support will continue without interruption. For instance, Raritan Bay Medical Center (RBMC), a health system directly over one of Hurricane Sandy’s projected paths in Northern New Jersey, is working to ensure that the two hospitals it operates will have sufficient staffing, supplies, and electricity to continue to provide care through the duration of the storm and for weeks after. This requires both physical safeguards (such as cleaning storm drains, boarding up or securing windows and doors, and tying down or removing loose objects and debris) and policy safeguards (including emergency communication systems, modifying staffing responsibilities, modifying orders to stockpile supplies). Other hospitals and health systems from Florida to Maine are conducting similar exercises to meet the needs of their patients and prepare for the worst.

II.  Are 1135 Waivers Likely to be Approved for Hurricane Sandy:

While providers are gearing up to meet the increased demand from Hurricane Sandy, it is important to look at prior weather disasters for hints on how the government will approach these situations. More specifically, the rules for coding and billing in emergency situations are often relaxed, and providers may qualify for waivers if their documentation of a specific service is weak or missing entirely. Section 1135 of the Social Security Act authorizes the Secretary of HHS to waive certain Medicare and Medicaid requirements in the face of a disaster. “Providers who provide such services in good faith can be reimbursed and exempted from sanctions (absent any determination of fraud or abuse).” See CMS Memo on Requesting a 1135 Waiver. This type of waiver was used, for instance, in the wake of Hurricane Katrina, and, in cases we have handled, many Administrative Law Judges have recognized that the provision of services during and after an emergency should be reimbursed (absent a determination of fraud or abuse). These are important factors to consider as health care practitioners treat the sick and wounded during the upcoming hurricane. Should events play out as forecasters have predicted, HHS will likely issue a blanket waiver for Hurricane Sandy as well.

Robert LilesRobert Liles is the managing member of Liles Parker PLLC. In our Washington, D.C. office, Robert handles compliance reviews, internal audits, Medicare and Medicaid overpayment appeals, fraud and abuse investigations, and a number of other health care matters. Should you have any questions, please feel free to call Robert today for a complimentary consultation at 1 (800) 475-1906.

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