On February 7, 2014, the Centers for Medicare and Medicaid Services (CMS) issued a memorandum that adds to the growing library of federal guidance on the permissibility of and limitations for health care providers and other entities paying the premiums of patients covered by qualified health plans (QHPs) in the health insurance exchanges or marketplaces. … Continue Reading
Health care fraud accounts for billions of the US health expenditure each year. This week HHS published a study addressing possible deficiencies in CMS’ capability to address fraud vulnerabilities and ensure the integrity of electronic health records (“EHR”) systems which CMS and its contractors use to pay Medicare claims. Concerns about whether CMS’ oversight and … Continue Reading
Recently, many stakeholders in the healthcare industry have expressed interest in implementing programs that provide funding to help patients with insurance premium payments. Until last week, it was unclear whether any type of premium assistance programs would be permissible under federal law. Finally, in Office of Inspector General (OIG) Advisory Opinion 13-19 posted on December … Continue Reading
The price of compliance may be high, but the price of non-compliance is even higher. Based on its recent $3 million data breach settlement, AvMed, and many other entities that have experienced data breach litigation, would likely agree that paying for security upgrades now, is far superior to paying for data breaches later. In 2009, … Continue Reading
In a policy memo published September 6, 2013, the Centers for Medicare & Medicaid Services (“CMS”) encouraged new owners of Medicare providers and institutional suppliers (“providers”) to accept automatic assignment of the seller’s Medicare Provider Agreement (“Agreement”) and CMS Certification Number (“CCN”). The overall goal appears to be to encourage automatic assignment in Change of … Continue Reading
Last Thursday, September 12, 2013, the Department of Health and Human Services (“HHS”) reported that the rate review provisions (the “Rate Review Provisions”) of the Affordable Care Act (“ACA”) saved an estimated $1.2 billion on health insurance premiums in 2012 for 6.8 million policyholders. The Rate Review Provisions are intended to increase transparency behind premium … Continue Reading
In response to a recently released Office of Inspector General (“OIG”) report that concluded CMS is overpaying many Critical Access Hospitals (CAHs), CMS pledged to reassess all CAHs’ certification. The report asserts that CMS could realize substantial savings by decertifying non-compliant CAHs because nearly two-thirds of CAHs would not meet the location requirements if required … Continue Reading
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
OIG 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
Yesterday, 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
As 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
As 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
For 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
On 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
The 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
Two 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
On 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
It 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
The 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
On 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
Next 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
The 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
Today, the United States Court of Appeals for the Sixth Circuit heard oral arguments in the appeal of Hadden v. United States, which involves questions of how much reimbursement Medicare can receive from tort/personal injury settlements. The Eleventh Circuit in Bradley v. Sebelius recently decided the issue against Medicare, as we reported earlier. Now, it is the … Continue Reading
In 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
