Health Care Law Blog

Dumping Medical Records Results in $800,000 HIPAA Fine for Health Care System

The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently announced that it reached a resolution agreement with a health care system in connection with alleged violations of the Health Insurance Portability and Protection Act of 1996 (HIPAA). Pursuant to the settlement, Parkview Health System, Inc. (Parkview) agreed to adopt a corrective action plan (CAP) to address deficiencies in its compliance program and to pay $800,000. 

As explained by OCR in a news release, Parkview, a covered entity under the HIPAA Privacy Rule, took custody of medical records of approximately 5,000 to 8,000 patients while assisting a retiring physician to transition patients to new providers, and while considering the purchase of some of the physician’s practice. Subsequently, Parkview employees, with notice that the physician was not at home, left 71 cardboard boxes full of medical records unattended and accessible to unauthorized persons on the driveway of the physician’s home. The physician complained, prompting the HHS investigation. Read More ›

Categories: Compliance, HIPAA, Providers

Health Facilities and Agencies Face Liability for Terminating or Dismissing Employees Who Report Malpractice

A recent decision by the Michigan Court of Appeals holds that a health facility or agency can be sued for taking or threatening disciplinary action against an employee for reporting or intending to report malpractice by a health professional. Employers should carefully review existing policies and practices, or if necessary, adopt appropriate policies, to protect against potential wrongful termination lawsuits. Read More ›

Categories: Compliance, Employment, Providers

HHS Report Reveals That Many Affordable Care Act Consumers Received Large Subsidies

In a recently released 26 page report the Department of Health and Human Services revealed that federal subsidies cover 76 percent of premiums for those who have signed up for coverage under the Affordable Care Act in the 36 federally administered markets. According to the Los Angeles Times, the total cost of subsidies could exceed $16.5 billion this year, which is significantly higher than the $10 billion cost that the Congressional Budget Office projected earlier this year. Read More ›

Categories: Health Care Reform, Health Insurance Exchange

Planning for CHOWs of Home Health Agencies and the 36-Month Rule

Due to regulatory and reimbursement constraints, health care providers are increasingly merging, affiliating, and acquiring other health care entities. In these transactions, the Medicare providers must identify whether a Medicare change of ownership (“CHOW”) will occur. Although it may appear, from a business standpoint, that a change of ownership will occur, the transaction may not necessarily be considered a CHOW for Medicare. Essentially, if the person or entity with ultimate responsibility for the provider changes, typically there will be a Medicare CHOW. Sometimes, but not always, this will be indicated by whether there has been a change in the taxpayer identification number.

CHOWs impact the Medicare provider agreement involved in the sale. Unless the buyer takes steps to affirmatively reject the seller's provider agreement, in a Medicare CHOW, the seller's provider agreement is automatically assigned to the buyer. This provides billing advantages for the buyer without having to enroll as a new Medicare provider, go through the initial enrollment process, and be re-surveyed or re-accredited, which takes several months.   Read More ›

Categories: Compliance, Medicare/Medicaid, Providers

Cracking Down on Fraud and Waste: OIG Releases Recommendations to Increase HHS Program Efficiency

In March of 2014, the Office of the Inspector General ("OIG") released the "OIG Compendium of Priority Recommendations." The recommendations offered are designed to help current programs for the Department of Health and Human Services ("HHS") run more effectively. The recommendation discussed twenty-five "opportunities" which, if addressed, would help to eliminate fraud and waste among HHS programs. The “opportunities” include the following: Read More ›

Categories: Compliance, Fraud & Abuse, Medicare/Medicaid, Providers

New requirements for tax exempt hospitals imposed by the Affordable Care Act

The Affordable Care Act, enacted on March 23, 2010, has established a number of new requirements that nonprofit hospitals must meet to maintain tax exemptions. Some of these new obligations, all codified in Section 501(r) of the Internal Revenue Code, include community health needs assessment and implementation, financial assistance and emergency care policies, limits on charges, and billing and collection restrictions.

In June 2012, the IRS released proposed regulations offering guidance to tax-exempt hospitals relating to certain provisions of Section 501(r). Although, the proposed regulations do not have the force of law, hospitals may rely on these to assist in implementing the requirements.

Below is a brief summary that highlights some of the new requirements for tax-exempt hospitals. Please refer to the full rule, Section 501(r) or contact us, to explore the extent of the new requirements in more detail.

Community health needs assessment and implementation (CHNA)

Effective for tax years beginning after March 23, 2012, hospital facilities must conduct a CHNA and adopt an implementation strategy at least once every three years. Read More ›

Categories: Health Care Reform, Hospitals

HHS Changes Policy, Expands Coverage for Physical Therapy

The New York Times recently reported that the Health and Human Services Department ("HHS") is changing its stance regarding Medicare payments for physical and occupational therapy treatments.  Previously, coverage was only afforded for treatment that actually helped to improve a patient's condition. Read More ›

Categories: Medicare/Medicaid

CMS Finalizes Changes to Unnecessary, Obsolete, Counterproductive or Excessively Burdensome Regulations

On May 7, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued a Final Rule to reform Medicare regulations identified as “unnecessary, obsolete, counterproductive or excessively burdensome” to hospitals and other health care providers. The changes are part of the Obama administration’s “regulatory lookback” in connection with Executive Order 13563, “Improving Regulation and Regulatory Review.” The Final Rule makes a number of clarifications and revisions to policies set forth in both the May 16, 2012 final rule and the February 7, 2013, proposed rule. CMS estimates the reforms could save providers nearly $660 million annually and $3.2 billion over five years.

Below is a brief summary that highlights some of the issues CMS is attempting to address. Please refer to the Final Rule, or contact us, to explore the full extent of the changes in more detail. Read More ›

Categories: Compliance, Hospitals, Medicare/Medicaid, Providers, Regulatory

Michigan Allowed to Move Dual Eligibles to Managed Care

Approximately 9 million people in the United States are covered by both Medicare and Medicaid, including seniors with low income and younger people with disabilities. These so-called "dual eligibles" often have complex and costly health needs, and lawmakers have been seeking ways to reduce costs while maintaining and improving care for this segment of the population. Traditionally, coverage and care for dual eligibles has tended to be fragmented and expensive given the challenges posed by separate entities (Medicare and Medicaid) with separate coverage policies.

A number of states, including Michigan, have been working with the Centers for Medicare and Medicaid Services (CMS) to develop proposals to address these challenges, based on new authority in the Affordable Care Act. Through this initiative, 15 states were granted federal funding to help them better coordinate care for dual eligibles. Each of the states, including Michigan, was awarded up to $1 million to help develop new strategies and programs addressing these challenges. Read More ›

Categories: Health Care Reform, Insurance, Medicare/Medicaid, Providers

Obama Administration Makes Changes to Medicare to Accommodate Same-Sex Marriages

On Thursday, April 3, 2014, the Obama administration announced that it was taking steps to bring its Medicare rules in line with the United States Supreme Court's ruling in US v. Windsor. Specifically, the Department of Health and Human Services (“HHS”) announced that same-sex marriages would be recognized for determining Medicare entitlement and eligibility. Read More ›

Categories: Employee Benefits, Insurance, Medicare/Medicaid, Providers