Health Care Law Blog

Nursing Homes Should Review Privacy Policies in Light of Recent CMS Guidance

A recent memorandum issued by the Centers for Medicare & Medicaid Services ("CMS") to state survey agency directors (the "Memorandum") discusses a nursing home's responsibility to protect residents' privacy, particularly with regard to social media. The Memorandum was issued following a series of media reports documenting the inappropriate posting of residents' photographs on social media by nursing home staff.  Read More ›

Categories: HIPAA, Medicare/Medicaid, Privacy

Data Breaches Lead to Record-Breaking HIPAA Settlement

HIPAAAdvocate Health Care Network (Advocate), one of the nation’s largest health care systems, recently reached a $5.55 million settlement with the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) for potential violations of the Health Insurance Portability and Accountability Act (HIPAA). The $5.55 million settlement is the largest HIPAA settlement in history against a single entity.

OCR's investigation arose after Advocate reported three separate data breaches to OCR that occurred between July and November of 2013. The first breach occurred when four desktop computers were stolen from an Advocate administrative building. Another breach occurred when an unencrypted laptop was stolen from an Advocate employee's unlocked vehicle. A third breach occurred when an unauthorized third party accessed the network of a company that provides billing services to Advocate. A total of more than 4 million patient records were affected by the breaches.  Read More ›

Categories: Audits, Compliance, HIPAA, News & Events

CMS Expands Temporary Home Health Agency Enrollment Moratorium to all of Michigan

The Centers for Medicare & Medicaid Services ("CMS") recently announced the statewide expansion of its temporary moratorium on the Medicare enrollment of new home health agencies ("HHAs"), subunits, and branch locations in Michigan.  As a result of the moratorium expansion, effective as of July 29, 2016, new HHAs in Michigan are precluded from enrolling in Medicare until the moratorium is lifted. The temporary moratorium also precludes the Medicare enrollment of new HHAs in Florida, Illinois, and Texas.   Read More ›

Categories: Medicare/Medicaid, Providers

CMS Issues Proposed Provider-Based Status Rules

On July 6, 2016, the Centers for Medicare & Medicaid Services ("CMS") released the 2017 Outpatient Prospective Payment System ("OPPS") Proposed Rule (the "Proposed Rule"). The Proposed Rule explains how CMS plans to implement Section 603 of the Bipartisan Budget Act of 2015 ("Section 603"), which established a new site neutral payment policy for certain off-campus hospital outpatient departments.

Section 603 provides that, as of January 1, 2017, certain items and services provided by off-campus hospital outpatient departments will no longer be reimbursed under the more favorable OPPS, and will instead be paid under another "applicable payment system." Read More ›

Categories: Billing/Payment, Medicare/Medicaid, News & Events, Physicians, Providers

Michigan’s Health Insurance Claims Assessment Act is Upheld Once Again

Court Michigan’s tax on paid health care claims is not preempted by ERISA, according to a decision by the United States Court of Appeals for the Sixth Circuit. On remand from the United States Supreme Court, the federal appellate court held that the Health Insurance Claims Assessment Act does not impermissibly interfere with the uniform administration of group health plans or impose additional burdens on self-insured plans and third-party administrators. Read More ›

Categories: 6th Circuit Court of Appeals, Insurance, News & Events, Tax

OCR Begins Phase 2 Audit Program of Covered Entities and Business Associates

AuditThe U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently announced that it has begun Phase 2 of its HIPAA audit program. This audit phase will impact covered entities and their business associates. Read More ›

Categories: Compliance, HIPAA, Hospitals, Providers

HHS Issues Final Rule Implementing ACA Nondiscrimination Provisions

The U.S. Department of Health & Human Services ("HHS") recently issued a final rule that implements the nondiscrimination provisions under Section 1557 of the Affordable Care Act (the "Final Rule"). The Final Rule becomes effective July 18, 2016. Read More ›

Categories: Health Care Reform, News & Events, Providers

Sixth Circuit Affirms Dismissal of FCA Whistleblower Lawsuit Based on Health Data Breach

WhistleblowerThe U.S. Court of Appeals for the Sixth Circuit recently affirmed a district court’s dismissal of a whistleblower lawsuit alleging violations of the False Claims Act based on an individual security breach. The case, United States ex rel. Sheldon v. Kettering Health Network, arose after the relator (or whistleblower) received letters from Kettering Health Network (KHN) informing her that KHN employees, including her now ex-husband, impermissibly accessed her medical records. Read More ›

Categories: 6th Circuit Court of Appeals, Compliance, HITECH Act, Providers

CARE Act Legislation Signed Into Law By Governor Snyder and Set to Take Effect July 12th

Patient Leaving HospitalThe Michigan CARE Act, recently signed into law by Governor Snyder, is set to take effect on July 12, 2016. Michigan becomes the 29th state to enact the CARE Act, which is intended to support and equip family caregivers with information and training when loved ones go into the hospital and as they transition home. A copy of Public Act No. 85 is available here. Read More ›

Categories: Compliance, Hospitals, News & Events

District Court Awards Summary Judgment to AseraCare in $200 Million Hospice False Claims Act Case

Health Care Summary JudgementOn March 31, 2016, the United States District Court for the Northern District of Alabama granted summary judgment for AseraCare in one of the largest False Claims Act (FCA) lawsuits against a hospice provider. In this whistleblower case, the government sought over $200 million, alleging that defendant AseraCare overbilled Medicare for hospice services by falsely certifying that patients were eligible for hospice care.

The litigation began when six AseraCare employees in Alabama, Wisconsin and Georgia (the "relators") filed whistleblower cases under the FCA. The employees alleged that AseraCare knowingly submitted false claims to Medicare by falsely certifying that patients met the Medicare eligibility requirements for the hospice benefit. In order to be eligible for the Medicare hospice benefit, a patient's physician must certify that "the individual's prognosis is for a life expectancy of 6 months or less if the terminal illness runs its normal course." 42 C.F.R. § 418.22(b)(1). The Department of Justice (DOJ) intervened in January 2012. Read More ›

Categories: Audits, Billing/Payment, Medicare/Medicaid, Providers