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Exercising Reasonable Care to Identify and Address Potential Overpayments

Posted on April 5, 2017 by

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 affirmative duty to exercise diligence […]

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

Posted on April 5, 2017 by

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 incentives for overutilization; and Performing “outlier” levels of […]

Best Practices in Compliance Program Operation

Posted on April 4, 2017 by

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 […]

CMS Extends Compliance Date for New Home Health Conditions of Participation

Posted on April 4, 2017 by

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, […]

When to Use the OIG’s Self Disclosure Protocols

Posted on March 30, 2017 by

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’s self-disclosure protocols is often very […]

Compliance Budgeting – Put Your Money Where Your Mouth is

Posted on March 30, 2017 by

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 organization follow the Code […]

When is a Physician Liable for Stark Law Violations?

Posted on March 30, 2017 by

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 […]

Hey Dentists: No Business Associate Agreement, No Problem

Posted on March 23, 2017 by

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, for the past few […]

Defining the Duty of the Board of Directors over Compliance Functions

Posted on March 22, 2017 by

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 […]

Excluded Party Cases Dominate OIG Published Self Disclosure Settlements

Posted on March 17, 2017 by

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 some of the questions previously […]