Proposed Rules Issued Extending Protections of Electronic Health Record Donations On April 10, 2013, the Department of Health and Human Services (DHHS), Office of Inspector General (OIG) and the DHHS, Centers for Medicare & Medicaid Services (CMS) each issued a proposed rule relating to the donation of interoperable electronic health records software or information technology… Continue Reading
Category Archives: Department of Health and Human Services
Subscribe to Department of Health and Human Services RSS FeedOIG Issues Special Fraud Alert: Physician-Owned Distributorships (PODs)
Posted in Department of Health and Human Services, Fraud and Abuse, Physician PracticeOIG Issues Special Fraud Alert: Physician-Owned Distributorships (PODs) On March 26, 2013 the Department of Health and Human Services, Office of Inspector General (OIG) issued a Special Fraud Alert: Physician-Owned Entities (Alert). The Alert focuses on the specific attributes and practices of “physician-owned entities that derive revenue from selling, or arranging for the sale of,… Continue Reading
Full Medicaid Expansion Required for States to See Full Federal Funding
Posted in Department of Health and Human Services, PPACAYesterday, the federal government announced that the federal government will not provide 100% funding for states that do not participate in the full Medicaid expansion contained in PPACA, as described by the Washington Post. Partial expansions will be permitted but will only receive matching federal money at the existing rate, at least for 2014-2017. As we… Continue Reading
HHS Guidance for De-Identification of PHI Under the HITECH Act
Posted in Department of Health and Human ServicesAs required by the HITECH Act, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) has issued guidance on two methods for de-identifying protected health information (PHI) under the Health Insurance portability and Accountability Act of 1996 (HIPAA) privacy rule.[1] “This guidance is intended to assist covered entities to understand… Continue Reading
OIG’s Continuing and New Reviews of the Medicaid Program: Managed Care
Posted in Department of Health and Human ServicesAs part of its Work Plan for Fiscal Year 2013, the Office of Inspector General (“OIG”) plans to focus on the following current and new issues in the Medicaid program: prescription drugs; home, community, and personal care services; equipment and supplies; state management and oversight; the Children’s Health Insurance Program; Medicaid data systems, controls, and… Continue Reading
Another Extension for States to Decide About Insurance Exchanges
Posted in Department of Health and Human Services, Payer/Insurance Reform, PPACAFor the second time in a week, the federal government has extended deadlines relating to state insurance exchanges. Today was originally the deadline for each state to submit an application to the federal government if the state would be running its own insurance exchange. For any state that does not set up its own exchange, the federal government… Continue Reading
Massachusetts provider settles HIPAA case for $1.5 million
Posted in Department of Health and Human Services, Fraud and AbuseOn September 17, 2012, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced that the Massachusetts Eye and Ear Infirmary and Massachusetts Eye and Ear Associates Inc. (collectively referred to as “MEEI”) agreed to pay $1.5 million to settle potential violations of the Health Insurance Portability and Accountability Act… Continue Reading
U.S. Supreme Court Rules the Individual Mandate Is Constitutional and Limits Medicaid Expansion Laws
Posted in Department of Health and Human Services, PPACAThe decision we’ve all been waiting for is in — the U.S. Supreme Court has ruled that the statute commonly known as the individual insurance mandate (everyone must have minimum health insurance coverage or pay a penalty) is constitutional under Congress’ taxing power. Because the individual mandate was upheld, the rest of the Affordable Care Act (“PPACA”) has also survived. The… Continue Reading
Make Your Voice Heard on the Direction of EHR MU Stage 3 Criteria
Posted in Department of Health and Human ServicesTwo workgroups that advise the Office of the National Coordinator for Health Information Technology seek input to identify ways in which Meaningful Use Stage 3 may advance the consistent delivery of high quality care in diverse care settings. The committees recently hosted a meeting of experts from health care delivery organizations, quality improvement organizations, industry,… Continue Reading
OIG Solicits Comments Regarding Revision to Self-Disclosure Protocol
Posted in Department of Health and Human Services, Fraud and AbuseOn June 18, the OIG published notice in the Federal Register advising that it is now soliciting information and recommendations for revising its provider self-disclosure protocol. [https://www.federalregister.gov/articles/2012/06/18/2012-14585/solicitation-of-information-and-recommendations-for-revising-oigs-provider-self-disclosure-protocol#p-13] The OIG’s self-disclosure protocol is a mechanism whereby providers may voluntarily disclose self-discovered evidence of potential violations of the Anti-Kickback Statute. Providers utilizing the protocol must disclose a… Continue Reading
GAO Recommends Changing Medicaid Audit Program Due To Poor Results
Posted in Department of Health and Human Services, Fraud and AbuseIt appears that the National Medicaid Audit Program hasn’t been worth the money it cost to run. According to published testimony released by the Government Accountability Office (GAO) today, only 4% of the 1,550 audits, though, resulted in refunds to the government of approximately $7.4 million. More than two-thirds of the audits found no overpayments. The remaining 27%… Continue Reading
Omnibus HIPAA Rule on the Horizon
Posted in Department of Health and Human ServicesLast week, Farzad Mostashari, national coordinator for health information technology, announced that the final omnibus HIPAA rule governing the privacy, security, breach notification and enforcement rules, and the Genetic Information Non-Discrimination Act, should be issued by the end of summer. Mr. Mostashari made the announcement during the opening keynote of the Health Privacy Summit in… Continue Reading
Privacy and Security Help Is On The Way
Posted in Department of Health and Human ServicesThe Chief Privacy Officer of the Office of the National Coordinator for Health Information Technology (“ONC”) recently released a new guide for providers and their staff to help understand HIPAA privacy and security when it comes to electronic health records (“EHRs”) and the meaningful use of EHRs. “Guide to Privacy and Security of Health Information”… Continue Reading
Proposed Rule for Overpayment Refunds — 10 year look-back and more
Posted in Department of Health and Human ServicesOn February 16, CMS published a proposed rule regarding providers’ obligation to return any overpayments within 60 days of identifying such overpayment. The proposed rule expounds on 60-day repayment obligation, which became effective in 2010 with the passage of PPACA, in ways that may give providers comfort in some areas but that will likely lead to… Continue Reading
Coming Monday — Supreme Court Arguments on PPACA
Posted in Department of Health and Human Services, PPACANext week, the drama begins — the Supreme Court will hold what promises to be the biggest (an impressive 6 hours) and most important series of oral arguments of the decade, if not the century — to decide the future of Obama’s health care reform, PPACA. The government will be primarily represented by Solicitor General Don Verilli; arguing most… Continue Reading
HHS Imposes First Civil Monetary Penalty for HIPAA Privacy Rule Violation
Posted in Department of Health and Human ServicesThe U.S. Department of Health and Human Services’ (“HHS”) Office for Civil Rights (“OCR”) issued a Notice of Final Determination finding that Cignet Health of Prince George’s County, MD (“Cignet”), violated the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). HHS imposed a civil money penalty (“CMP”) of $4.3 million… Continue Reading
More Medicare Subrogation Issues Pending Before the Sixth Circuit Court of Appeals
Posted in Department of Health and Human ServicesToday, the United States Court of Appeals for the Sixth Circuit heard oral arguments in the appeal of Hadden v. United States (pdf), which involves questions of how much reimbursement Medicare can receive from tort/personal injury settlements. The Eleventh Circuit in Bradley v. Sebelius (pdf) recently decided the issue against Medicare, as we reported earlier. Now, it… Continue Reading
MSP Manual Not Entitled To Deference and Medicare Does Not Have Priority to Recover From Wrongful Death Settlement
Posted in Department of Health and Human ServicesIn a decision that has garnered significant commentary, the United States Court of Appeals for the Eleventh Circuit recently held that the Medicare Secondary Payer (“MSP”) Manual is not entitled to deference in deciding the amount the Medicare program can recover from wrongful death settlements. In doing so, the court rejected Medicare’s claim it could recover the… Continue Reading
Chipping Away at the Health Reform Act
Posted in Department of Health and Human Services, PPACAIt’s way too soon to know what will eventually come of PPACA, but it stands to reason that no law of this magnitude has ever been implemented without some revision. Reform is never a singular act, but rather a process that must be organic if it is to attain its desired objectives.
Happy Half-Birthday ACA!
Posted in Department of Health and Human Services, PPACAThe Patient Protection and Affordable Care Act (ACA) was passed on March 23, 2010. On September 23, ACA’s six-month anniversary, a number of provisions regulating health insurance plans will go into effect: 1. Health plans are required to allow individuals up to age 26 may remain on a parent’s plan. Although regulations aren’t yet final,… Continue Reading