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Showing 42 posts in Compliance.

Can a Non-Physician Own and Operate a Medical Facility in Michigan?

An interesting case is winding its way through the Michigan Court of Appeals that involves the question of whether a layperson, as opposed to a licensed physician, can own a for-profit business that provides medical services. Read More ›

Categories: Compliance, Licensing, Providers

CMS Delays Enforcement of Nursing Home Mega Rule

Mega Rule Enforcement DelayedThe Centers for Medicare & Medicaid Services ("CMS") recently announced that they will delay enforcement penalties related to Phase 2 of their revised nursing home Requirements for Participation (commonly referred to in the industry as the "Mega Rule"). Read More ›

Categories: Compliance, Long Term Care, Medicare/Medicaid, News & Events, Providers

CMS Releases 2018 Inpatient PPS Proposed Rule

Medicare and Medicaid ServicesOn April 14, 2017, the Centers for Medicare & Medicaid Services issued its 2018 Medicare Inpatient Prospective Payment System proposed rule (the “Proposed Rule”). The Proposed Rule was published in the Federal Register on April 28, 2017, and comments will be accepted through June 13, 2017.

The Proposed Rule suggests a number of changes that would affect hospital rates, inpatient quality reporting and readmissions reduction programs. Some of the most significant changes are highlighted below. Read More ›

Categories: Compliance, Medicare/Medicaid, Providers

What’s Next After Health Care Bill’s Failure in Congress?

Affordable Care ActDespite controlling the presidency, and both houses of Congress, the Republican’s bid to repeal and replace the Affordable Care Act (ACA) failed. The Republican’s replacement bill - the American Health Care Act (AHCA) - was pulled before proceeding to a vote in the U.S. House of Representatives, as it apparently lacked the votes to pass. Here’s what businesses need to know now that this (first?) attempt to repeal the ACA failed. Read More ›

Categories: Compliance, Insurance

CMS Announces New Conditions of Participation for Long-Term Care Facilities

Recently, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (“Final Rule”) updating the Medicare Conditions of Participation (“CoPs”) for long-term care (“LTC”) facilities. It is the first time in over 15 years that substantial LTC CoP revisions have been released.

LTC facilities affected by the Final Rule include skilled nursing facilities for Medicare and nursing facilities for Medicaid, or those facilities that are duly certified. The Final Rule took effect on November 28, 2016, however CMS has planned for a phased implementation. LTC providers must complete the three implementation phases by November 28 in the years 2016, 2017 and 2018, respectively. CMS has estimated that the costs of compliance will be $62,900 in the first phase of implementation, and $55,000 per year for phases two and three. Read More ›

Categories: Compliance, Long Term Care, Medicare/Medicaid, News & Events, Pharmacy, Providers

CMS Final Rule on Reporting and Returning of Overpayments Has Potentially Only an Eight-Month Safe Harbor

The Final Rule on Reporting and Returning of Overpayments (“Final Rule”), which became effective on March 14, 2016, requires Medicare providers to report and return Medicare overpayments by the later of (i) 60 days after the date on which the overpayment was identified, or (ii) the date on which any corresponding cost report was due. This 60-day deadline for returning overpayments is suspended when any of the following occurs: Read More ›

Categories: Billing/Payment, Compliance, Medicare/Medicaid

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

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

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

fca whistleblower lawsuitThe 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

care act legislationThe 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