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Apply the 60-Day Rule to Medicaid Overpayments

Posted on May 30, 2019 by

The Affordable Care Act requires any person who has received an overpayment from certain defined government health programs to report and return the overpayment within 60 days after the overpayment is identified.  If an overpayment is not repaid, or if a self-disclosure is not made before the expiration of the 60-day period, the overpayment amount […]

The Federal Government Really Wants You to Take Self Disclose

Posted on May 28, 2019 by

The Department of Justice (DOJ) along with other health care fraud enforcement agencies, continue to send strong signals that they want businesses to police themselves for potential compliance issues and self-disclose where infractions are found.  The fact of the matter is the government simply does not have enough resources to track down and take action […]

The Essence of Compliance – Compliance Officer Authority and Resource Allocation

Posted on May 24, 2019 by

How Are Compliance Budgeting and Compliance Officer Autonomy Tied Together When Assessing Compliance Effectiveness? The Department of Justice (“DOJ”)’s compliance program evaluation identifies the need to allocate sufficient revenues to the compliance program as one of the key issues that indicates compliance program effectiveness.  The issue of resource allocation has been identified since the early […]

HIPAA this, HIPAA that. Everything is a HIPAA Issue. Deconstructing the “HIPAA Bias.”

Posted on May 21, 2019 by

HIPAA, as a body of regulations protecting the confidentiality of patient health care information, has been branded very effectively.  Most staff at your average health care facility know about HIPAA and that it protects the confidentiality of a patient’s health care information.  They understand they cannot go home and discuss patients they treat and that […]

DOJ’s New Evaluation of Corporate Compliance Programs – A Good Time to Focus on the Essence of Compliance

Posted on May 20, 2019 by

The Criminal Division of the United States Department of Justice (DOJ) recently released an update (April, 2019) to its Evaluation of Corporate Compliance Programs (Evaluation).  The Evaluation was first introduced in 2017 to provide guidance for prosecutors to consider when conducting investigations, determining whether to bring charges, and negotiating plea and other agreements.  The Evaluation […]

New CMS Rules for Inpatient Rehabilitation

Posted on May 13, 2019 by

Well, it’s a start.  New Medicare rules kicked in starting January 1, 2019 that are aimed at focusing less provider time on paperwork and more on patient care in inpatient rehabilitation facilities.  Any change that reduces paperwork in this overregulated area is welcome, but the actual impact of the announced changes are incremental at best. […]

CMS Proposes Rule to Ease Compliance Requirements

Posted on October 22, 2018 by

Last month, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule designed to, in CMS’s words, “relieve burden on healthcare providers by removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements for healthcare facilities”.  CMS estimates that the annual savings to healthcare providers would be $1.2 billion. The proposed rule is some […]

OIG Opinion on Donation of Telehealth Equipment

Posted on September 5, 2018 by

A recent Advisory Opinion (Advisory Opinion 18-03) from the Office of Inspector General (OIG) of the Department of Health and Human Services addresses potential kickback issues involved in the donation of telehealth equipment.  The OIG has issued opinions addressing technology donation in the past, but not directly involving telemedicine and not involving services that were […]

Hospital Program for Free Support Services for Caregivers – Approved by OIG

Posted on August 30, 2018 by

A recent Office of Inspector General (OIG) advisory opinion approved a proposal under which a hospital has established a caregiver center that provides or arranges for free or reduced-cost support services to caregivers in the local community (Arrangement).  The OIG, basing its opinion on the facts provided, concluded that it would not impose sanctions even […]

Non-Economic Damage Limitation Upheld by the Wisconsin Supreme Court

Posted on July 11, 2018 by

The Wisconsin Supreme Court has issued a ruling in the case of Mayo v. Wisconsin Injured Patients and Families Compensation Fund.  The Supreme Court’s decision, which was handed down on June 27, 2018, overturned a lower court decision that found the non-economic damage cap to be unconstitutional.  The 5-2 decision of the Wisconsin Supreme Court […]