The Department of Health and Human Services (HHS) recently announced its decision to significantly reduce the maximum annual penalties it will impose on health care providers for violating the Health Insurance Portability and Accountability Act (HIPAA). HHS previously applied the same maximum…
CMS recently announced new value-based care payment models aimed at transforming primary care in order to deliver better value for patients across the healthcare system. Participation in the payment models will be available starting in January 2020 and is anticipated to attract 25% or more of…
Measuring corporate compliance program “effectiveness” is recommended by several authorities, including the United States Sentencing Commission[1] and the Department of Health and Human Services’ Office of Inspector General (“OIG”)[2]. The goals of an assessment process should be: (1) to identify…
The day any enterprise starts contemplating a bankruptcy filing never is a happy one. If the enterprise is in the health care industry, added anxiety can arise over whether it qualifies as a “health care business” under the United States Bankruptcy Code. Among other provisions applicable to a…
A new bill recently cleared Indiana’s legislature that will change the requirements of Indiana’s Scheduled Prescription Electronic Collection and Tracking (“INSPECT”) program. The bill modifies the changes enacted last year that made failure to check the INSPECT database prior to prescribing an…
If you are a health care clinic or other office setting, do you have a policy that governs those individuals or “business invitees” who may request and be granted the opportunity to observe or participate in some aspect of your business or clinical operations for a legitimate business purpose?…
Beginning in April 2019, CMS started returning OPPS claims where the Hospital Outpatient Department address on the claim does not match the exact address appearing on the hospital’s Medicare Form 855A.
These include claims returned for using “Ste.” instead of “Suite” or “St.” instead of “Street.”
Be…
On March 27, 2019 the IRS announced that taxpayers can no longer request an employer identification number (“EIN”) unless the “responsible party” named on the application has a Social Security number (“SSN”) or Individual Taxpayer Identification Number (“ITIN”). This change goes into effect on May…
The United States Department of Justice (“DOJ”) issued a press release regarding a recent $2 Million settlement related to allegations that a provider violated the False Claims Act by submitting inflated and upcoded evaluation and management (“E/M”) claims to Medicare and Medicaid, over a five year…
On February 14, 2019, the Center for Medicare and Medicaid Innovation (“CMMI”) announced a new payment model for Medicare emergency ambulance services called the “Emergency Triage, Treat and Transport (“ET3”) Model. The goal of the ET3 Model is to allow Medicare Fee-For-Service beneficiaries to…
On March 21, 2019, the Office for Civil Rights (“OCR”) at the U.S. Department of Health and Human Services (“HHS”) issued a resolution to resolve complaints brought against the State of Hawaii by two pregnancy resource centers (the “Centers”). The Centers brought the complaints in 2017 alleging…
D.C. District Court Judge James Boasberg invalidated Federally approved Medicaid work requirements in Kentucky and Arkansas and sent the question back to the Centers for Medicare and Medicaid Services (“CMS”) for further analysis. The March 27, 2019 decision is a legal setback for CMS and states…
