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CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018

Posted on February 17, 2017 by

On February 17, 2017, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule aimed at reforming and stabilizing the individual and small group health insurance markets. When (or if) finalized, the proposed rule would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community […]

Confidentiality of Alcohol and Drug Abuse Patient Records – Final Rule Revising Regulations

Posted on February 17, 2017 by

The Department of Health and Human Services (HHS) has released a final rule to update and modernize the Confidentiality of Alcohol and Drug Abuse Patient Records regulations effective February 17, 2017. The new regulations contain special confidentiality restrictions relating to information pertaining to patients receiving treatment for a substance use disorder under a Federal program.  […]

Home Health Agency Final Conditions of Participation Revisions Released by CMS

Posted on February 14, 2017 by

The Center for Medicare and Medicaid Services has issued a final rule that revises and modernizes the Conditions of Participation (COP) for Home Health Agencies.  The Final Rule can be found in its entirety at: Final Home Health Rule (CMS-3819-F). The new Rule describes the conditions Home Health Agencies (HHA) must meet in order to […]

Wisconsin DHS Prohibits Maneuvers and Techniques in Community Based Programs

Posted on February 10, 2017 by

The Wisconsin Department of Health Services (DHS) released a memo specifying maneuvers or techniques that may not be used at any time in community based programs and facilities. DHS deems the prohibited maneuvers or techniques to “present an inherently high risk of serious injury and even death.”  Providers are directed by DHS to immediately discontinue […]

Compliance Officer and Legal Counsel Relationships

Posted on February 9, 2017 by

I am often asked my opinion whether a general counsel can also serve in the role of compliance officer.  At first blush, it seems the general counsel would be a perfect fit for the role because of general knowledge of regulations applicable to the organization.  Clients are often surprised when I tell them it is […]

OIG Report Indicates Areas of Hospice Fraud Vulnerability and Issues a Warning to Hospice Providers

Posted on January 27, 2017 by

The HHS Office of Inspector General recently released a report indicating deficiencies in hospice election statements and physician certification of patient eligibility for hospice care.  Medicare hospice care provides help to patients who are terminally ill continue life with minimal disruptions.  In order to qualify for hospice benefits, a physician must certify the patient is […]

Lessons Learned from Recent OCR Settlements

Posted on January 26, 2017 by

We can learn some valuable lessons about compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) from settlements that are announced by the U.S. Department of Health and Human Services, Office for Civil Rights (OCR).  These settlements give us guidance of issues OCR considered important as well as their interpretation of various […]

Recent Health Care Legal Developments – Looking Forward to 2017

Posted on December 28, 2016 by

As we are coming close to the end of another year, I thought it might be good to pull together some of the health law articles and blogs we produced during 2016.  Ruder Ware’s Health Care Focus Team puts out a lot of information on a variety of different blog sites.  This is in addition […]

HHS Releases Inflation Adjusted Federal Civil Penalties

Posted on November 18, 2016 by

The Department of Health and Human Services has issued new interim final rules to adjust a variety of Federal Civil Penalties for inflation.  The Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 required the agency to promulgate a “catch-up adjustment” in these penalties through an interim final rule.  Additionally, HHS agencies were instructed […]

When Can Violation of a Condition of Participation Result in False Claims Act Liability? Update on Escobar’s Materiality Standard

Posted on November 17, 2016 by

In June, I published a blog article on a decision of the United States Supreme Court that appeared to change the law applicable to “false certification” in the 7th Judicial Circuit Circuit.  The Supreme Court decision in Universal Health Services v. United States ex rel. Escobar, 136 S. Ct. 1989 (2016), (“Escobar”) opened the door to […]