Cannabis Law and FWA
What is fraud
Knowingly and willfully executing a scheme to defraud a health care benefit program. Example: • Coding to a higher level of service • Billing for services that were never provided • Misrepresenting a diagnosis to increase revenue • Upcoding can lead to audits and penalties
What class is a 4th degree false claims penalty?
class E felony = commits fraud in 5th degree and receives payments within 1 year over $3000
What is the purpose of the Deficit Reduction Act of 2005?
slow spending in Medicare and Medicaid (creates financial incentives for states to enact anti-fraud legislations)
What are the cannabinoid hemp product requirements?
- 0.3% THC (delta 8,9,10) - cannot contain alcohol/ nicotine/ tobacco - not if a form of a cig, pre-roll, etc.. - not added to food products - not synthetic cannabinoids
What are the requirements and rules for a person licensed as a cannabinoid hemp retailer?
- cannot sell to anyone under 21yo - good moral character - cannot dispense injectables, inhalers, flower, anything smoking related
Who is required to have a compliance program in NYS?
- hospitals, nursing homes, RHCF - home health care - mental health
What are the requirements for food/beverage hemp products?
- limit of 25mg per package - (supplement) no more than 3g total; 75mg per serving - must have measuring device
If more than 500 PTs were involved in the HIPAA breach, what do you do?
- report incident to PTs involved and HHS within 60 days of incident - report to local news
If less than 500 PTs were involved in a HIPAA breach, what do you need to do?
- send a letter to each PT involved within 60 days - report to HHS within 60 days of the end of the year
What does a compliance program need to contain?
- written policies - designate employee responsible for daily operations - training of all employees - communication lines to compliance officer - disciplinary policies - system for routine identification of compliance risk areas - systems for responding to issues - policies for reporting
How long do you need to keep records for Medicare?
10 years
How many technicians are allowed per pharmacist?
4 technicians per 1 pharmacist
How many plants can an adult over 21yo grow recreationally?
6 plants per person (max of 12 in a household)
How long do you need to keep records for Medicaid?
6 years
What is FERA?
= fraud enforcement and recovery act 2009 - inc funding for enforcing False Claims Act
What is the only FDA-approved CBD product?
Epidiolex (treats seizures)
Can you look at your own health profile?
No (HIPPA violation) you can only look at a health profile with that person's permission
Can property owners refuse to rent to someone who uses cannabis?
No, but they can ban it on the premises
Can an individual sell the recreational marijuana they grow?
No, personal use only
What did the Marijuana Regulation and Taxation Act establish?
Office of Cannabis Management (governed by Cannabis Control Board)
What is waste?
The overutilization or inappropriate utilization of services and misuse of resources
What class of misdemeanor is a 5th degree false claims penalty?
class A
What class is a 1st degree false claims penalty?
class B felony = commits fraud in 5th degree and receives payments within 1 year over $1,00,000
What class is a 2nd degree false claims penalty?
class C felony = commits fraud in 5th degree and receives payments within 1 year over $50,000
What class is a 3rd degree false claims penalty?
class D felony = commits fraud in 5th degree and receives payments within 1 year over $10,000
What is the Anti-Kickback Stature: Social Security Act?
criminal offense to knowingly and willfully offer/pay/solicit/receive any remuneration to induce/reward items be a federal health care program
Does a government agency need a subpoena to ask for medical records/ HIPAA info?
does not need a subpoena in an emergency (COVID)
What is Enterprise Corruption?
having knowledge of the existence of a criminal enterprise and the nature of its activities, and being employed by or associated with such enterprise
Where can a registered technician compound?
in hospitals and pharmacies owned by hospitals
What is abuse?
includes actions that may, directly or indirectly, result in unnecessary costs to the Medicare Program - misusing codes on a claim - charging excessively for services
What is a safest way to release medical records to a PT?
mailing it to the address on file (can release to PT in pharmacy but not the safest)
Is it legal to market CBD by adding it to food / labeling it as a dietary supplement?
no
Is the odor of cannabis a reasonable determination that a crime has been committed?
no (cant search vehicle)
What is the max percentage of THC allowed d/t the Agriculture Improvement Act of 2018?
no more than 0.3% (anything over is considered a controlled substance under federal law)
What is the Federal False Claims Acts?
protects whistleblowers and imposing penalties for fraud
What does qui tam mean?
whistleblower
