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Showing 44 posts in Compliance.

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

Recent Seven Figure Settlements Underscore the Importance of HIPAA Compliance, Particularly in Light of OCR’s Announced Increase in Audit Activity

Recent Seven Figure Settlements Underscore the Importance of HIPAA Compliance, Particularly in Light of OCR’s Announced Increase in Audit ActivityThe Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently announced that it reached resolution agreements and corrective action plans with two health care entities - a health system and a research institution - in connection with alleged violations of the Health Insurance Portability and Protection Act of 1996 (HIPAA). These cases underscore the importance of ongoing HIPAA compliance vigilance by covered entities and business associates, particularly in light of OCR’s recent announcement that it has commenced Phase 2 of its audit program. Read More ›

Categories: Audits, Compliance, HIPAA, Providers

Is Losing Money by Employing Physicians a Stark Violation?

losing money by employing physiciansModern Health Care has reported that hospitals often lose approximately $176,000 a year per each employed physician.

While this initially seems like a surprising statistic, it is understandable that hospitals lose money when they employ physicians. Physicians in private practice often pay their staff less than comparable hospital employees. When a hospital buys a physician’s practice, the benefit costs typically increase if the staff receives the hospital’s fringe benefit package. Moreover, hospital overhead is typically higher than a private physician practice with regard to HR costs and other support services.

Many systems claim that the only way to manage the health of a given population (which is what ACO and other similar payment structures are requiring) is to be fully integrated with employed physicians, so covering the losses incurred by employing physicians is the necessary cost of preparing for the new paradigm. The ugly, and legally problematic, truth is that most health systems look beyond the income generated by physicians for treating patients but also at income from physician ancillary referrals to justify the economic losses caused by acquiring physician practices. This raises concerns under the Stark law. Read More ›

Categories: Billing/Payment, Compliance, Hospitals, Medicare/Medicaid, Physicians

Tuomey Health Loses Appeal, Facing $237 Million in Fees and Damages

A very long legal battle may be nearing its final chapter after the U.S. Court of Appeals for the Fourth Circuit upheld a $237 million judgment against Tuomey Healthcare System in South Carolina. The judgment is an enormous sum for the regional health system and hospital, with even one of the Court of Appeals judges calling it a "death sentence." A three-judge panel heard the case at the Court of Appeals, so Tuomey could still seek reconsideration from all the judges of that Court or take the case to the U.S. Supreme Court. It may also opt to find a new partnership to keep the hospital afloat. Read More ›

Categories: Compliance, News & Events, Physicians, Providers

Joint Guidance for Health Care Boards Released by HHS OIG and Industry Leaders

health care boardsOne of the most important responsibilities that governing boards of healthcare organizations (“Boards”) have is carrying out their compliance oversight obligations. Recently the U.S. Department of Health and Human Services Office of Inspector General (OIG) released a new guide to assist Boards in carrying out their compliance duties. The guide is titled “Practical Guidance for Health Care Governing Boards on Compliance Oversight” (“Guidance”) and was developed in collaboration with the American Health Lawyers Association (AHLA), the Association of Healthcare Internal Auditors (AHIA) and the Health Care Compliance Association (HCCA).  Read More ›

Categories: Compliance, News & Events

The IRS Provides Temporary Relief for Certain Health Reimbursement Arrangements

health reimbursement arrangementsOn February 18, 2015, the Internal Revenue Service (“IRS”) provided further guidance related to the issue of how certain employer health insurance reimbursement arrangements are treated under the Affordable Care Act (“ACA”).

As we explained in a previous post, after the Health Insurance Marketplace opened for business, many employers recommended that their employees use it to purchase individual health insurance policies, with the promise that the premium costs would be reimbursed by the employer. In fact, such employee reimbursement strategies were aggressively marketed to employers as a solution to reduce costs and comply with the requirements of the ACA. Little did these employers (and marketers) know, such arrangements exposed the employers to significant penalties under the ACA. 

Prior guidance made clear that such arrangements – whether funded on a pre- or post-tax basis – may be subject to the ACA’s market reforms. Employers that offer reimbursement arrangements that violate the ACA are subject to a $100 per day per affected employee penalty.

Notice 2015-17 clarifies previous guidance and provides transition relief to certain small employers from ACA penalties. Key aspects of the new guidance are noted below. Read More ›

Categories: Compliance, Employee Benefits, Health Care Reform, Health Insurance Exchange, Medicare/Medicaid, Tax

PPACA's Employer Mandate Draws Near…Non-Calendar Plans Beware!

As is well known by now, transitional relief from the Patient Protection and Affordable Care Act's Employer Mandate in 2015 is available for certain applicable large employers that sponsor non-calendar year health plans. This transitional relief allows the employer to avoid penalties for those months of 2015 that predate the first day of the non-calendar plan year. What is not so well-known, however, are the requirements that must be met in order for the employer to be entitled to receive the transitional relief. Read More ›

Categories: Compliance, Employee Benefits, Health Care Reform, Providers

HIPAA Deadline Quickly Approaching – Are your Business Associate Agreements Up To Date?

business associate agreementsThe Final HIPAA Omnibus Rule ("Final Rule"), published January 25, 2013, contains several new requirements for business associate ("BA") agreements. While the requirements went into effect on September 23, 2013, grandfathered BA agreements that were in place prior to January 25, 2013 were deemed to be in compliance for one year. Now that the one year expiration of the deemed compliance is quickly approaching, covered entities and business associates must ensure that their grandfathered BA agreements are updated to comply with the Final Rule before the September 22, 2014 deadline.

To meet the deadline, covered entities and business associates should review and update all existing BA agreements to determine whether they are HIPAA-compliant. The Final Rule also requires business associates to have written BA agreements with their subcontractors that comply with the new requirements. Read More ›

Categories: Compliance, HIPAA

OIG Issues Special Fraud Alert on Clinical Laboratory Payments to Physicians

clinical laboratory paymentsThe Office of the Inspector General for the United States Department of Health and Human Services (the “OIG”) recently issued a Special Fraud Alert regarding laboratory payments to referring physicians (the “Alert”). The Alert relates to two types of compensation arrangements - Specimen Processing Arrangements and Registry Arrangements - between clinical laboratories and physicians who order clinical laboratory tests that the OIG believes present a substantial risk of fraud and abuse under the federal anti-kickback statute. Read More ›

Categories: Compliance, Fraud & Abuse, Physicians