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When Does a HIPAA Breach Exist?

Posted on April 3, 2018 by

Conducting HIPAA Breach Risk Assessments The HIPAA rules relating to assessment of potential patient confidentiality breaches were changed in 2013.  Specifically, on January 17, 2013, the Office of Civil Rights released new regulations defining when a HIPAA breach is deemed to occur.  These regulations recast the steps that covered entities are required to take when […]

Changes in Federal Enforcement Cases and the Stark Law May Benefit Health Care Providers

Posted on March 16, 2018 by

Some recent changes in federal law and in federal agency interpretation of federal law may both clarify and relieve some regulatory obligations of health care providers. Lessening Dependence on Federal Agency Interpretations of Federal Law In late January, a high ranking official of the U.S. Department of Justice (DOJ) told DOJ litigators they can no […]

Will Centers for Medicare & Medicaid Services (CMS) Really Make Changes to the Stark Law?

Posted on February 26, 2018 by

If you navigate to the American Hospital Association (AHA) Interactive Town Hall of January 17, 2018, you can view a video in which Seema Verma, the current Administrator of the Centers for Medicare and Medicaid Services, discusses some of the efforts currently underway at CMS to ease the burden of applicable regulations through the Medicare […]

Opioid Fraud and Abuse as a Compliance Risk Area

Posted on February 20, 2018 by

The opioid epidemic is different than other drug related social problems because, in many cases, addiction to opioids starts in the medical office or in the pharmacy; in most cases through the treatment of legitimate physical pain and often chronic pain.  As such, the marketing practices of companies who manufacture, market, and distribute these highly […]

Federal Government Will Seek Dismissal of False Claims Act Cases That Lack Merit

Posted on November 28, 2017 by

A top official in the U.S. Department of Justice (DOJ) recently announced a major change in the federal government’s position on claims brought under the False Claims Act (FCA).  Michael Granston, the director of DOJ’s Civil Frauds Section, the section that handles health care fraud and other FCA cases, stated that the DOJ will ask […]

Inspector General Audit Could Impact Skilled Nursing Facilities

Posted on September 12, 2017 by

Skilled nursing facilities (SNF) may see even more scrutiny from the Centers of Medicare and Medicaid Services (CMS) because of a recent audit conducted by the Office of Inspector General of the U.S. Department of Health and Human Services.  The audit looked into abuse and neglect of Medicare recipients residing in SNFs and the associated […]

Antitrust Challenge to Narrow Network Products – 7th Circuit Rules in Favor of Exclusive Agreement

Posted on June 28, 2017 by

The health care market has recently seen a resurgence in narrow network products.  To a significant degree, the resurgence of these products has been driven by the need for managed care plans looking for new avenues to help reduce the cost of care.  Traditionally, health care plans have been able to manipulate risk through exclusion […]

Medicaid Fraud Control Units Report Focus on Personal Care Services

Posted on June 27, 2017 by

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released a report summarizing activities of State Medicaid Fraud Control Units (MFCUs or Units) for fiscal year 2016.  The OIG is the designated Federal agency for oversight of state MFCUs.  The report found a total of 1,564 convictions of which approximately […]

Free Parking, Yes, But No Stark Law Claim

Posted on June 21, 2017 by

A federal court recently dealt a victory to a health care provider over whistleblower allegations that free parking and valet service at a medical office building violated the Stark Law and the Anti-Kickback Statute.  In Bingham v. BayCare Health System (No. 8:14-cv-73, M.D. Fla.), a federal district judge adopted the report and recommendation of a […]

Reminder: New Voluntary Self-Referral Disclosure Effective June 1

Posted on May 31, 2017 by

As discussed in a previous blog, beginning on June 1, 2017, health care providers of services and suppliers wanting to voluntarily disclose actual or potential violations of the Stark Law must follow a new process finalized by CMS.  Previously, health care providers and suppliers were able to submit a self-disclosure of an actual or potential […]