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CLIENT ALERT: Ohio Managed Care Organization (MCO) Open Enrollment

Client Alert
May 1, 2018

Open Enrollment started April 30, and will continue through May 25, 2018, for your MCO (Managed Care Organization).  Every State Fund Ohio employer can select their MCO for the coming policy year.  The MCO is responsible for helping to manage Ohio Workers’ Compensation claim costs.  All State Fund employers will begin to receive correspondence urging them to select that particular MCO, or urging them not to make a switch.               

 

Legislation introduced in 1993, which eventually became law after amendments, made managed health care a part of the Ohio Workers’ Compensation system.  That system has evolved over the years, and MCOs now make initial decisions involving most medical management issues in state fund claims.  Their importance cannot be overstated, as the medical management often dictates the path a particular claim will take.  It would be a mistake for any State Fund Ohio employer to simply allow the “default” MCO manage their claims.  Instead, they should examine their MCO (every State Funded employer has one – and if the employer has not selected one, then one is selected for that employer at random), and decide whether they want to switch or keep their MCO.

 

The Ohio BWC provides helpful information for those looking for basic information (which can be found at https://www.bwc.ohio.gov/downloads/brochureware/brochures/MCOGuide.pdf).  Of course, anyone who wants to discuss their overall claims situation is free to contact Richard Williger, and I’d be happy to spend some time looking at their overall Experience.

Workers' CompensationManaged Care Organizations
Client Alert

Friendly Physician Models: The Basics Through 5 Frequently Asked Questions

October 27, 2023During the past several years, many health law practices have noticed a dramatic increase in the number of telehealth businesses and private equity backed health care providers. Both of these trends often rely heavily on corporate structures commonly referred to as “friendly physician,” “captive PC” or “MSO” models. Although friendly physician models are used by non-physician health care providers (e.g., physical therapists, psychologists, and dentists), this article focuses on physicians and how the model is used in connection with the provision of professional medical services.Client Alert

The DOL and EEOC Enter a Partnership to Strengthen Federal Employment Law Enforcement

October 23, 2023On September 13, the U.S. Department of Labor’s (DOL) Wage and Hour Division and the Equal Employment Opportunity Commission (EEOC) entered into a Memorandum of Understanding (MOU) agreeing to work together in enforcing federal employment laws. The MOU forms a partnership between the two agencies to encourage coordination through information sharing, joint investigations, training, and outreach.Client Alert

Proposed Laboratory Arrangement Draws Heightened Scrutiny from the OIG

October 18, 2023On September 25, 2023, the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) issued Advisory Opinion 23-06 (AO). The Opinion involved a proposed arrangement between an independent laboratory and other physician laboratories for the purchase of the technical component of anatomic pathology services. The OIG ultimately concluded that the arrangement at issue, if it was entered into with the requisite intent, would implicate the Federal Anti-Kickback Statute (AKS) and constitute grounds for sanctions.Client Alert

SMALL BUSINESS ALERT: January 1, 2024 - Beneficial Ownership Information Reporting

October 13, 2023Beginning on January 1, 2024, many small businesses across the United States will have to report personal information about their owners, beneficial owners, and others who own or exercise control over the company. The information will have to be reported to, and maintained by, the Financial Crimes Enforcement Network (“FinCEN”) as part of the Beneficial Ownership Information Rule. FinCEN is a bureau of the U.S. Department of the Treasury.Client Alert

Health Care Inclusivity for the LGBTQIA+ Community

October 5, 2023Healthcare providers, regardless of practice setting, should be aware of the healthcare disparities for LGBTQIA+ individuals, and ways in which they can be more inclusive of these individuals by making modifications to their practices.
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