In the first known case involving a wireless provider, a cardiology service provider agreed to pay a $2.5 million settlement based on the impermissible disclosure of unsecured electronic protected health information (ePHI)....more
5/4/2017
/ Data Breach ,
Data Security ,
Electronic Protected Health Information (ePHI) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Laptop Computers ,
Mobile Devices ,
OCR ,
Risk Assessment ,
Risk Mitigation ,
Security Standards ,
Settlement
In a previous blog post, I promised to release a list of questions a Board of Directors (Board) might ask its compliance officer. This post is intended to fulfill that promise. My intent is to help Board members exercise...more
The Board of Directors (Board) of an organization has oversight responsibilities over the compliance program. Board members are often unsure of the nature and scope of their responsibilities over compliance. The roll of many...more
We hear a lot about potential liability under the False Claims Act (FCA) for the failure to repay overpayments within 60 days of discovery. Focus on the 60-day rule has taken focus away from the potential for criminal charges...more
4/14/2017
/ 60-Day Rule ,
Criminal Penalties ,
Criminal Prosecution ,
False Claims Act (FCA) ,
Federal Criminal False Claims Statute ,
Felonies ,
Health Care Providers ,
Overpayment ,
Overpayment Recovery Time Limits ,
Provider Self-Disclosure Protocol ,
Yates Memorandum
A relatively recent case involving buy-in terms in an ambulatory surgery center demonstrates how different valuations for referral sources and non-referral sources can be evidence of remuneration under the Medicare...more
Medical practices that routinely use laser technology are subject to some of the same legal issues as other types of practices. Use of lasers creates additional compliance issues and highlights certain compliance risk areas....more
4/10/2017
/ 60-Day Rule ,
Compliance ,
False Claims Act (FCA) ,
Fraud ,
Fraud and Abuse ,
Healthcare Fraud ,
HIPAA Audits ,
Medicare ,
Physicians ,
Risk Assessment ,
Risk Mitigation ,
Telehealth
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...more
4/7/2017
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Corrections ,
Medical Devices ,
Pharmaceutical Industry ,
Physician Payments ,
Physicians ,
Prescription Drugs ,
Social Security Act ,
Sunshine Act ,
Teaching Hospitals
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...more
4/6/2017
/ Bribery ,
Compliance ,
Cooperation ,
Corporate Misconduct ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
Federal Pilot Programs ,
Federal Sentencing Guidelines ,
Foreign Corrupt Practices Act (FCPA) ,
Health Care Providers ,
Individual Accountability ,
Internal Investigations ,
Remediation ,
Self-Disclosure Requirements ,
Voluntary Disclosure ,
White Collar Crimes ,
Yates Memorandum
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...more
Three relatively recent cases involving dermatology billing practices illustrate some of the main compliance risks faced by dermatology practices...more
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...more
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. ...more
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....more
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...more
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...more
3/21/2017
/ Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
Exclusion List ,
Federal Health Care Programs (FHCP) ,
Health Care Providers ,
Medicaid ,
Medicare ,
Medicare Billing Privileges ,
OIG ,
Provider Self-Disclosure Protocol ,
Settlement
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...more
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...more
Medicare permits a physician to bill for certain services furnished by a nurse practitioner or other auxiliary personnel under what is referred to as the "incident to" billing rules. The "incident to" rules permit services...more
One of the primary elements in a Compliance Program is the creation of a system that permits employees and others to provide information regarding potential compliance issues without fear of retaliation. In larger...more
Recent OIG Release Emphasizes Need for Compliance Policies Specific to Provider Risks The Office of Inspector General recently published results of its audit of Medicare claims for chiropractic services made by a chiropractic...more
How Fraud and Abuse Cases Arise in a Medical Practice -
It is no secret many doctors work very long days. Some days are worse and some are better than others. As a compliance lawyer, my job is to attempt to prevent...more
The Department of Justice issued a directive entitled “Evaluation of Corporate Compliance Programs.” The document provides insight into the analysis used by the DOJ to assess the effectiveness of a corporate compliance...more
An interesting development transpired Tuesday, February 21, 2017 in a case pending in Federal District Court in the District of Columbia that challenges subsidy payments from the Federal Treasury to support Obamacare. The...more
2/24/2017
/ Affordable Care Act ,
Barack Obama ,
Constitutional Challenges ,
Delays ,
Executive Orders ,
Health Insurance Exchanges ,
Healthcare Reform ,
Low-Income Issues ,
Motion To Stay ,
Political Parties ,
Popular ,
Subsidies ,
Trump Administration ,
U.S. Treasury
On January 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued Recommendations to Providers Regarding Cyber Security. In general, the Recommendations are intended to remind providers and suppliers to keep...more
A few months ago, the Atlanta Journal-Constitution reported on the guilty plea of an Atlanta dentist for Medicaid fraud. Just this week, the dentist was sentenced to serve a year and a half in federal prison....more