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Health Care

  • Disputing Inaccurate Reports Under the Physician Payment Sunshine Act

    Posted on April 6, 2017, Authored by John H. Fisher, II, Filed under Health Care

    The Affordable Care Act added the Physician Payment Sunshine Act (Sunshine Act) as section 1128G to the Social Security Act. The Sunshine Act requires applicable manufacturers of drugs, devices, biologicals, or medical supplies and certain group purchasing organizations to report annually to the Centers for Medicare & Medicaid Services (CMS) ce…   

  • New Safe Harbor Permits Some Free Transportation to Patients

    Posted on April 6, 2017, Authored by Emilu E. C. Starck, Filed under Health Care

    A new safe harbor was recently issued by the Health and Human Services (HHS) Office of Inspector General (OIG) that permits eligible health care providers to offer free or discounted transportation to established patients.  The safe harbor addresses concerns that offering free goods and/or services to patients might be considered payment of illegal…   

  • Sally Yates was Already Famous for Changing the Focus of Compliance Investigations - The Yates Memorandum

    Posted on April 5, 2017, Authored by John H. Fisher, II, Filed under Health Care

    By now the whole world knows about Sally Yates.  We are likely to see a lot more of her as a central figure in Congressional investigations.  For some of us who deal with compliance investigations, Sally Yates was famous long before her refusal to defend the immigration ban.  She was the author of the famous “Yates Memorandum” that changed the focu…   

  • Exercising Reasonable Care to Identify and Address Potential Overpayments

    Posted on April 5, 2017, Authored by John H. Fisher, II, Filed under Health Care

    When the Center for Medicare and Medicaid Services (CMS) finally issued final regulations under the 60-day repayment rule, it implemented a new standard requiring a provider to affirmatively exercise reasonable diligence to identify potential overpayments.  This was a change from the proposed regulations that held providers to a much lower affirmat…   

  • Three Recent Fraud Cases Involving Dermatologists Illustrate Primary Compliance Risks in Dermatology Practices

    Posted on April 5, 2017, Authored by John H. Fisher, II, Filed under Health Care

    Three relatively recent cases involving dermatology billing practices illustrate some of the main compliance risks faced by dermatology practices.  These risk areas include: Improper use of multiple removal CPT codes; Billing for “impossibly long days”; Failure to follow supervisions rules required to permit “incident to” billing; Creating in…   

  • Best Practices in Compliance Program Operation

    Posted on April 4, 2017, Authored by John H. Fisher, II, Filed under Health Care

    Given the increased importance of compliance, it is helpful for providers to get a feel for what constitutes “best practice” when operating a compliance program.  “Best Practices” is a term thrown around all of the time in the business world.  It is used in many contexts and takes on a variety of meanings depending on who is using it and for what p…   

  • CMS Extends Compliance Date for New Home Health Conditions of Participation

    Posted on April 4, 2017, Authored by John H. Fisher, II, Filed under Health Care

    In February, we reported on revisions to the Conditions of Participation for Home Health Agencies (HHA) released by the Centers for Medicare & Medicaid Services (CMS).  CMS has now proposed the effective date of new Conditions of Participation (CoP) be delayed by six months.  The original effective date of the new regulations was July 13, 2017.…   

  • When to Use the OIG’s Self Disclosure Protocols

    Posted on April 3, 2017, Authored by John H. Fisher, II, Filed under Health Care

    The HHS Office of Inspector General offers providers an opportunity to self-disclose certain violations in exchange for avoiding some of the more draconian penalties that may otherwise apply under applicable regulations.  Even though the OIG’s Provider Self-Disclosure Protocols (“SDP”) can be very compelling, the decision whether to utilize the OIG…   

  • Compliance Budgeting – Put Your Money Where Your Mouth is

    Posted on March 31, 2017, Authored by John H. Fisher, II, Filed under Health Care

    You have adopted your basic compliance policies and procedures, established a reporting system and visibly rolled out your new compliance program.  Your board of directors has passed a resolution decisively stating its commitment to compliance.  The CEO issued a letter stating her commitment to compliance and mandating every person in the organizat…   

  • When is a Physician Liable for Stark Law Violations?

    Posted on March 30, 2017, Authored by John H. Fisher, II, Filed under Health Care

    I frequently hear attorneys claim the Stark law applies equally to hospitals and physicians.  This position is sometimes taken in the process of negotiating a transaction between a hospital and a physician or physician group.  In this context it is limited to simple posturing to attempt to get a better financial deal in the negotiated arrangement. …   

  • Hey Dentists: No Business Associate Agreement, No Problem

    Posted on March 23, 2017, Authored by Ruder Ware Attorneys, Filed under Health Care

    According to the U.S. Health and Human Services Office for Civil Rights (OCR), dental practices are not required to have a business associate agreement with their dental laboratory before sharing protected health information. The HIPAA Privacy Rule applies to covered entities (including dental practices) and their business associates.  As you know…   

  • Defining the Duty of the Board of Directors over Compliance Functions

    Posted on March 22, 2017, Authored by John H. Fisher, II, Filed under Health Care

    I recently posted a blog article about a document released by the Department of Justice entitled “Evaluation of Compliance Programs.”  As the title of the document might suggest, the DOJ release covers a variety of issues it looks at when evaluating the effectiveness of compliance programs.  The document includes some guidance on how a corporate bo…   

  • Excluded Party Cases Dominate OIG Published Self Disclosure Settlements

    Posted on March 21, 2017, Authored by John H. Fisher, II, Filed under Health Care

    In 2013, the HHS Office of Inspector General issued revised protocols outlining the process through which health care providers are able to self-disclose and resolve potential liability under the OIG’s civil monetary penalty (CMP) authorities.  The 2013 Self Disclosure Protocols (SDP) clarified the process of self-disclosure and provided answers to…   

  • Physician Practice Compliance Programs

    Posted on March 15, 2017, Authored by John H. Fisher, II, Filed under Health Care

    In today’s environment of complex regulations, aggressive prosecution, exorbitant penalties, and hungry whistleblower attorneys, it is necessary for medical practices to maintain effective compliance programs.  Failure to do so puts the practice at a great deal of unnecessary risk.  Many or most practices will eventually make errors in their billin…   

  • Enforcing ASC Exclusion Provisions While Minimizing Legal Risk – Rethinking Strict Application of the Safe Harbors to Exclusion Decisions

    Posted on March 3, 2017, Authored by John H. Fisher, II, Filed under Health Care

    Many surgery centers are eventually faced with decisions about how to treat investing physicians who do not perform as many procedures in the surgery center as others.  Under performing physicians can create political issues in ASCs because investors who perform more surgeries or higher value procedures at the center feel the other investors are ta…