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…
The Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information Technology for Economic and Clinical Health or “HITECH” Act (hereinafter “HIPAA”)1 establishes numerous obligations for HIPAA covered entities and business associates.
One obligation, in…
The Indiana Administrative Code, specifically 844 IAC, Article 5, establishes certain professional standards for physicians licensed in the State of Indiana. One particular section, 844 IAC 5-2-16, sets forth requirements governing the discontinuation of a physician’s practice due to retirement or…
A former Patient Information Coordinator (Patient Coordinator), previously employed with UPMC and its affiliate, Tri Rivers Musculoskeletal Centers (TRMC) in Mars, Pennsylvania, pleaded guilty to a charge of wrongfully disclosing health information, in violation of the Health Insurance Portability…
In an opinion issued on February 25, 2019, the Illinois Appellate Court confirmed that a not-for-profit hospice provider was not entitled to a charitable use property tax exemption because it was not exclusively engaged in charity care. See Midwest Palliative Hospice and Care Center v. Constance…
A new year means “New Year’s Resolutions.” Many people commit to financial resolutions for 2019, whether it is eliminating debt or creating a monthly budget. Unfortunately, they neglect their estate plans. Adding estate planning to your resolutions is important for a variety of reasons, whether you…
The Office of Medicaid Policy and Planning finalized a rule impacting applied behavioral analysis (ABA) Therapy services effective March 1, 2019. Affected services providers should review and revise business policies and practices to accommodate these new changes as applicable. Note that the final…
The process for dealing with Medicare or Medicaid overpayments is essential to any health care organization. The mishandling of overpayments can result in substantial corporate liability, including potential claims of wrongful retention of overpayments in violation of the False Claims Act. Every…
The Health and Human Services Office of Civil Rights (“OCR”) recently entered into its final Resolution Agreement of 2018 to resolve HIPAA allegations involving Cottage Health, a California health system that serves patients throughout the state. Cottage Health provided notice of breaches of…
