Most healthcare providers understand that routinely waiving patient cost-sharing obligations creates compliance issues under the Anti-Kickback Statute, the Civil Monetary Penalties Law, and third-party payor agreements which...more
Providers will often pay physicians for serving in important administrative roles within the organization. Compensation for administrative services can create risk to the organization under multiple laws, including the...more
One of the fundamental compliance requirements for healthcare providers is protecting the confidentiality and security of the patient health information you maintain. Most healthcare providers are subject to a federal law...more
Has a patient asked you or one of your providers if they could record a conversation or interaction with you? Would your staff know how to handle such a request? Requests from patients and their families to record...more
One of the biggest changes in healthcare over the past 15 years has been the move to electronic medical records. In 2009, only 12% of hospitals and 22% of physician practices utilized a certified electronic health record. As...more
We talk frequently on the podcast about how important it is for providers to find compliance issues early so they can correct them and self-report if needed. One way to find compliance issues early is for your employees and...more
Lack of transportation can be a significant barrier to accessing healthcare services. According to a Robert Wood Johnson Foundation report, one in five patients report forgoing needed healthcare services due to lack of...more
There has been much publicity surrounding the Centers for Medicare and Medicaid Services’ (“CMS”) new minimum staffing requirements for long-term care facilities scheduled to take effect starting in 2026 for non-rural...more
The healthcare industry remains a popular target for ransomware attacks. If you haven’t been impacted by a ransomware attack, it’s likely only a matter of time before someone you do business with or buy services from is...more
6/10/2024
/ Business Associates ,
Cyber Attacks ,
Cybersecurity ,
Data Breach ,
Data Security ,
Hackers ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Information Technology ,
Popular ,
Ransomware
Does your compliance program incorporate quality and patient safety issues? Or, are you treating the two areas as separate and distinct departments? The OIG’s General Compliance Program Guidance recommends all healthcare...more
Earlier this month, HHS unveiled updated Section 1557 regulations which will impact most healthcare providers, including for the first time Medicare Part B providers who do not participate in other federal programs like...more
Every day, new articles extol the benefits of artificial intelligence (AI) within the healthcare industry. If you aren’t already using generative AI tools, it’s likely only a matter of time....more
Audits are an important part of a compliance program and help monitor compliance obligations, identify non-compliance, and quantify overpayments. But, planning the audit is often just as important as the audit itself. One of...more
We often work with valuation experts to ensure compensation payments between healthcare organizations and physicians are fair market value and commercially reasonable for purposes of compliance with the Stark Law and the...more
4/26/2024
/ Anti-Kickback Statute ,
Compliance ,
Fair Market Value ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Physicians ,
Settlement ,
Stark Law ,
Valuation ,
Whistleblowers ,
White Collar Crimes
Compliance is a “team effort.” Everyone in the organization has an important role to play. It’s critical, however, that each member of the team understand their specific role and how it relates to compliance. Compliance...more
Most healthcare providers understand the importance of having a designated Compliance Officer. Someone needs to lead the organization’s compliance initiatives and be responsible for advising the CEO and governing body of...more
Given the highly regulated nature of healthcare, it should come as no surprise that most healthcare providers have a designated compliance officer tasked with overseeing the implementation and management of the organization’s...more
Healthcare providers, their employees, medical staff, and patients have long been protected by Federal conscience protections preserving their right to participate in, or refuse to participate in, lawful activities which may...more
Fiscal year 2023 saw record recoveries and the highest number of settlements and judgments ever under the Federal False Claims Act. According to a new report released by the United States Department of Justice (“DOJ”), the...more
3/4/2024
/ Anti-Kickback Statute ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Final Judgment ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Fraud ,
Qui Tam ,
Regulatory Violations ,
Settlement ,
Whistleblowers
Fiscal year 2023 saw record recoveries and the highest number of settlements and judgments ever under the Federal False Claims Act. According to a new report released by the United States Department of Justice (“DOJ”), the...more
Diabetes and obesity drugs have skyrocketed in popularity as of late. According to a report released by Trilliant Health in September 2023, healthcare providers in the United States wrote more than 9 million prescriptions for...more
In November 2023, the United States Health & Human Services Officer of Inspector General (“OIG”) issued new compliance program guidance for the healthcare industry, referred to as the General Compliance Program Guidance...more
When was the last time your organization received an anonymous compliance concern? Has it been so long you can’t recall? Maybe you consider yourself lucky that the organization has never received a concern on your watch, or...more
2/8/2024
/ Anonymity ,
Anti-Corruption ,
Compliance Management Systems ,
Corporate Governance ,
Corporate Management ,
Corporate Misconduct ,
Employer Liability Issues ,
Health Care Providers ,
Healthcare Facilities ,
Internal Reporting ,
Whistleblowers ,
White Collar Crimes
Is your organization’s culture complimenting your healthcare compliance program? Does it enhance and maximize your program’s effectiveness? Or, is your culture secretly sabotaging your compliance efforts?...more
Are you a health care provider who received funds from the Health Resources and Services Administration's ("HRSA' s") COVID-19 Uninsured Program? If so, more inquiries and repayment demands may be coming....more