San Rafael rent control case could impact thousands

SAN RAFAEL, Calif. (KGO) -- Residents of a San Rafael mobile home park won a major victory Monday in a case that could affect hundreds of thousands of California mobile home residents. The multi-million dollar legal battle pits a company controlled by one of the richest men in America against the city of San Rafael and the Contempo Marin mobile home park.

At first glance, you might think life at Contempo Marin looks idyllic. But former resident Jacqui Garcia says that's an illusion. "I get very angry about what's happened to so many people that have had to walk away," she said.

Garcia lived at Contempo Marin for 30 years, in a home protected by rent control.

Former San Rafael City Councilman Greg Brockbank says mobile home parks are "one of our best examples of affordable housing." "It gives us the diversity we need to have a healthy community," he said. "It provides us with people that work in the community, that retire in the community."

But things at Contempo Marin changed 13 years ago when the park owner Equity LifeStyle Properties (ELS) sued to end rent control. Contempo Marin is like most mobile home communities; residents own their houses but rent the land under them. Despite their name, the homes are actually not very mobile.

About 100 California cities and counties have rent control laws to protect to the homeowners. The San Rafael case could affect them all.

Attorney Michael Von Loewenfeldt is representing the city of San Rafael. "Because (mobile home owners) don't own the land under their homes, they are really subject to abuses or potential abuses by the landowner," he said.

In 2008, ELS tried to raise rents from $700-$800 a month to almost $2,000 a month. A judge stopped that, but the legal battle is still going and it's taken an emotional toll on many residents.

ELS is the biggest mobile home park owner in the country. The chairman of the board is Sam Zell, estimated by Forbes to be worth $4 billion. Last month residents of ELS communities in seven states showed up outside a shareholder meeting in Chicago to accuse the company of excessive rent increases.

"Seniors are actually walking into the manager's office and turning in the key to their house and walking away, losing everything," Carla Burr, a mobile home resident from Virginia, said.

Residents at Contempo Marin say that's happening at their park too. They are caught in legal limbo. Five years ago, a federal judge ruled San Rafael's rent control law was unconstitutional. Then, last April the appeals court reversed that decision.

But the president of the homeowners association, Keith Meloney, says it's too soon to celebrate. He told residents, "While there is a time for our victory dance, it is not yet today."

ELS is fighting the court ruling. For now, if any one moves out of their home, rent control on that space goes away and ELS can raise the rent as high as it wants. That's already happened on more than 60 of about 400 spaces at the park.

In court papers filed last week, residents claim ELS is trying to drive them out.

Gordon Atkinson is the attorney for Contempo Marin residents. He feels so strongly about the case he is doing it for free. Atkinson says the court documents include statements from residents who say they are being harassed. "They say that the park owner is not taking care of the park, that conditions are deteriorating, that they are selectively enforcing rules against some homeowners, but not other homeowners," he said.

Residents who want to sell are struggling. Their houses have lost almost all their value because of the uncertainty over future rent. Andrew Perrins has family and health issues and needs to move. Perrins says he bought his house for $160,000. "Just a few years later, due to the legal actions of the owners of the landowner, my house is now worth less than $5,000," he said.

Jacqui Garcia was so desperate to get out, she's selling her home for just $300. "There was no peace of mind anymore," she said. "You lived in constant fear, what are you going to get hit with next?"

In court documents, ELS calls the residents claims of harassment "erroneous assertions."

No one from Equity LifeStyle Properties would not talk on camera. Instead, they sent the following statement:

We filed a petition for rehearing with the full 9th Circuit U.S. Court of Appeals because we believe that the 3-judge panel's opinion was in conflict with U.S. Supreme Court rulings. As discussed in our petition, the trial court found after a full trial that the City's rent control ordinance does not make housing more affordable, a conclusion the 3-judge panel did not dispute. Instead, the ordinance forces new residents to pay more upfront to get into the community than they would have to pay without the ordinance. Our customers are overwhelmingly satisfied with the quality and pricing of the communities and lifestyle we provide. We invest large amounts of money in maintaining and upgrading our communities every year. Last year alone, we invested tens of millions of dollars in property upgrades.

Monday, the federal appeals court refused to re-hear the case -- a major victory for the mobile home owners. However, Equity Lifestyle Properties has 90 days to appeal to the U.S. Supreme Court.

There are an estimated 350,000 mobile homes in communities throughout California.

Written and produced by Jennifer Olney

(Copyright ©2013 KGO-TV/DT.

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The Fiscal Cliff Postponed – The Impact on EdTech

In the last two weeks, it’s been pretty much impossible to ignore the looming Fiscal Cliff. Going over the cliff was discussed as funding Armageddon, which would have negatively impacted schools in a very meaningful way. Now, with a short term solution in place, we’re left without the clarity we’d all like to have for the long term. However, given what has happened, we can make some general observations that will serve us well for at least the remainder of this school year.

With the current bill that has just been signed into law, there is a tremendous lack of clarity on how spending cuts in this legislation will actually impact education. Further, there is no completed deal and the same issues will once again be raised before this temporary reprieve ends on March 30th. The good news is that with this timing, we are likely to get through this educational year (2012-2013) without any major impacts. It is a good idea to complete any technology purchases or additions prior to March 30 if at all possible given the pending recurrence of the fiscal cliff. I wouldn’t be surprised if many school systems “push through” technology purchases this year. It just makes sense.

Listening to the rhetoric and evaluating how key politicians are discussing changes in domestic spending, it appears that there are some trends emerging that may not be wholly positive for technology spending in primary education. One of the key trends may be a focus on loans and grants for college education that could take a larger part of Federal education spending, and may be exacerbated if the total amount of discretionary spending for education is cut. In addition, spending for student centric programs such as Head Start are unlikely to be reduced, creating further pressure on budgets for EdTech.

If the final resolution to the current budget situation results in real cuts to education spending at the Federal level, cities, towns, and school districts may look to state governments to help make up the shortfall that occurs from a reduction of Federal programs. This is problematic on many fronts. First, the majority of state budgets were not in strong shape even prior to the Fiscal Cliff. States such as California, New Jersey, Illinois, Florida and Massachusetts are already struggling with large shortfalls and some are looking to cut reimbursements for education expenses in the coming year. The second problem is that cuts from Fiscal Cliff spending reductions are also likely to impact the states as well due to a reduction in the amount of overall aid to individual states. This only exacerbates the problem of looking for state funding. Based on what we know today, increases in state funding for K-12 technology purchases are not likely and may possibly decrease.

The Fiscal Cliff issue has not been solved, just kicked down the road to March 30th, and making firm plans for the future is quite difficult. With the likelihood of some cuts, making technology purchases now can be an important tactic to insure that you don’t end up with IT issues or needs that might not be funded in the future. We will know more going forward, but until there is a long term solution to the Fiscal Cliff in place, it’s best to act tactically, and get what you need while you can.

View the original article here

The Impact of RACs on Your Medical Practice

Please sit down — this will not be an easy article to digest, no matter how carefully I parse my words. Life under the microscope of Recovery Audit Contractors is going to get tougher for physicians. Three recent developments may impact your practice in the next year.

I have written in the past on RACs and documented their growth from a twinkle in Uncle Sam's eye to the behemoths they have become. Much of the advice offered in prior articles (please see links at the bottom of this article) remains valid and should be heeded.

Audits of Level 5 E&M services

CMS has given approval to Connelly, the Region C RAC, to perform complex medical reviews on level 5, E&M services (e.g., 99215, 99205, and 99255). This is the first time CMS has given any RAC permission to target the coding and documentation of E&M services. One impetus for the focus on level 5 E&M services is a shift in providers' use of level 4 and 5 codes. According to the Center for Public Integrity, the percentage of Medicare services coded as level 4 or level 5 increased from 25 percent to 40 percent between 2001 and 2010. This, of course, has increased CMS's financial outlay for these services and made them a much larger budget item (i.e., target).

Connelly is the RAC for thirteen states: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. Take note: the other three RACs are expected to follow suit.

Since early 2009, the Medical Group Management Association, AMA, and 101 state and specialty societies have actively opposed RAC audits. It is unfortunate for all of us that CMS has not heeded their advice.

There is yet another cause for concern with this initiative. Though it has not been officially confirmed, CMS apparently has given Connelly permission to extrapolate the results of their E&M audits. For instance, if a RAC audit determined that six of twenty (30 percent) level 5 services did not meet coding/documentation guidelines, the RAC would have authority to extrapolate this 30 percent failure rate across all level 5 services provided during the review period.

If you provide level 5 services, it is prudent to have several of them copiously reviewed by a certified professional coder.

9th Circuit Court of Appeals verdict

On September 11, 2012, the U.S. Court of Appeals for the Ninth Circuit rendered a dangerous opinion. It affirmed that RACs are not restricted by regulatory deadlines, statutes of limitations, or time limits. Lead plaintiff attorney Ronald S. Connelly, of Power Pyles Sutter & Verville PC, says "The decision leaves providers with absolutely no finality in their payments from the Medicare program. Contractors could reopen claims that are even 10 or 20 years old, and providers would have no right to challenge the timeliness of the audit."

Legal minds will weigh in on this opinion in the weeks and months to follow, but again, a scary precedent has been set. It may mean that Medicare patient and billing records should be maintained indefinitely. At a minimum, it means the past is neither safe nor sacred.

I recommend you contact your medical malpractice insurance carrier to determine if this circuit court opinion will change their recommendations for records retention.

EHR automated notes

Last but not least, the HHS's Office of Inspector General has set its focus on whether providers are using automated note generation appropriately in their EHRs. Also known as "cloned notes," automated notes and templates use copied and pasted data on multiple patients to record standard information such as a normal review of systems or physical exam.

An observer reviewing several such notes would find virtually identical documentation and very little patient-specific information. Herein lies the OIG's concern. They are concerned that cloned notes may lead to over-documentation or a lack of patient-specific information. From a medical malpractice liability perspective, the same concerns apply.

There is a place for structured notes, and many physicians used them prior to the advent of EHRs. These are acceptable, and EHR-generated notes that contain patient specific documentation should be good to go as well. Your risk lies in over-cloning identical text in your patient notes.

In summary

The United States Department of Justice (DOJ) has three top priorities:

• Terrorism
• Violent crimes
• Healthcare fraud

I wish healthcare fraud were not on this list, but it is, and it is not dropping off the list anytime soon. Government oversight and second-guessing are givens for anyone who practices medicine today; expect fraud identification and enforcement initiatives to grow.

To get a head start on audit-proofing your practice, read the following articles that offer advice and practical tips for protecting both yourself and your practice:

• Avoid Medicare Fraud Claims by Coding Correctly

• Medicare's Fraud and Abuse Program

• Nine Things to Know About RACs

Lucien W. Roberts, III, MHA, FACMPE, is vice president of Pulse Systems, Inc., and a former practice administrator. For the past 20 years, he has worked in and consulted with physician practices in areas such as compliance, physician compensation, negotiations, strategic planning, and billing/collections. He can be reached at lroberts@pulseinc.com.

View the original article here

The Impact of RACs on Your Medical Practice

Please sit down — this will not be an easy article to digest, no matter how carefully I parse my words. Life under the microscope of Recovery Audit Contractors is going to get tougher for physicians. Three recent developments may impact your practice in the next year.

I have written in the past on RACs and documented their growth from a twinkle in Uncle Sam's eye to the behemoths they have become. Much of the advice offered in prior articles (please see links at the bottom of this article) remains valid and should be heeded.

Audits of Level 5 E&M services

CMS has given approval to Connelly, the Region C RAC, to perform complex medical reviews on level 5, E&M services (e.g., 99215, 99205, and 99255). This is the first time CMS has given any RAC permission to target the coding and documentation of E&M services. One impetus for the focus on level 5 E&M services is a shift in providers' use of level 4 and 5 codes. According to the Center for Public Integrity, the percentage of Medicare services coded as level 4 or level 5 increased from 25 percent to 40 percent between 2001 and 2010. This, of course, has increased CMS's financial outlay for these services and made them a much larger budget item (i.e., target).

Connelly is the RAC for thirteen states: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. Take note: the other three RACs are expected to follow suit.

Since early 2009, the Medical Group Management Association, AMA, and 101 state and specialty societies have actively opposed RAC audits. It is unfortunate for all of us that CMS has not heeded their advice.

There is yet another cause for concern with this initiative. Though it has not been officially confirmed, CMS apparently has given Connelly permission to extrapolate the results of their E&M audits. For instance, if a RAC audit determined that six of twenty (30 percent) level 5 services did not meet coding/documentation guidelines, the RAC would have authority to extrapolate this 30 percent failure rate across all level 5 services provided during the review period.

If you provide level 5 services, it is prudent to have several of them copiously reviewed by a certified professional coder.

9th Circuit Court of Appeals verdict

On September 11, 2012, the U.S. Court of Appeals for the Ninth Circuit rendered a dangerous opinion. It affirmed that RACs are not restricted by regulatory deadlines, statutes of limitations, or time limits. Lead plaintiff attorney Ronald S. Connelly, of Power Pyles Sutter & Verville PC, says "The decision leaves providers with absolutely no finality in their payments from the Medicare program. Contractors could reopen claims that are even 10 or 20 years old, and providers would have no right to challenge the timeliness of the audit."

Legal minds will weigh in on this opinion in the weeks and months to follow, but again, a scary precedent has been set. It may mean that Medicare patient and billing records should be maintained indefinitely. At a minimum, it means the past is neither safe nor sacred.

I recommend you contact your medical malpractice insurance carrier to determine if this circuit court opinion will change their recommendations for records retention.

EHR automated notes

Last but not least, the HHS's Office of Inspector General has set its focus on whether providers are using automated note generation appropriately in their EHRs. Also known as "cloned notes," automated notes and templates use copied and pasted data on multiple patients to record standard information such as a normal review of systems or physical exam.

An observer reviewing several such notes would find virtually identical documentation and very little patient-specific information. Herein lies the OIG's concern. They are concerned that cloned notes may lead to over-documentation or a lack of patient-specific information. From a medical malpractice liability perspective, the same concerns apply.

There is a place for structured notes, and many physicians used them prior to the advent of EHRs. These are acceptable, and EHR-generated notes that contain patient specific documentation should be good to go as well. Your risk lies in over-cloning identical text in your patient notes.

In summary

The United States Department of Justice (DOJ) has three top priorities:

• Terrorism
• Violent crimes
• Healthcare fraud

I wish healthcare fraud were not on this list, but it is, and it is not dropping off the list anytime soon. Government oversight and second-guessing are givens for anyone who practices medicine today; expect fraud identification and enforcement initiatives to grow.

To get a head start on audit-proofing your practice, read the following articles that offer advice and practical tips for protecting both yourself and your practice:

• Avoid Medicare Fraud Claims by Coding Correctly

• Medicare's Fraud and Abuse Program

• Nine Things to Know About RACs

Lucien W. Roberts, III, MHA, FACMPE, is vice president of Pulse Systems, Inc., and a former practice administrator. For the past 20 years, he has worked in and consulted with physician practices in areas such as compliance, physician compensation, negotiations, strategic planning, and billing/collections. He can be reached at lroberts@pulseinc.com.

View the original article here