Date archive: April 2015

Happy HIPAA Thursday – Paper Records Count too!

Just ask Cornell Prescription Pharmacy about disposal of unshredded paper pharmacy records containing protected health information (PHI), and you will hear that this pharmacy paid $125,000 plus it has entered a Resolution Agreement with the OCR.  Not only is this pharmacy paying a significant penalty, it will be under a corrective action plan to correct…

EEOC Releases Proposed Rule on Employer Wellness Programs and the ADA

The EEOC release, to which a link is below, provides guidance on how employers can incorporate wellness programs into their group health plans. While employers may provide incentives if employees participate in wellness programs, including health questionnaires or medical examinations, the programs must be voluntary.  Furthermore, any data obtained from the employer wellness programs may…

Senate Passes “Fix” to 21% Scheduled Reduction for the Physician Fee Schedule

Please see the notice below from the CMS MLN Connects Network. The Senate has acted to avoid the impact of the Physician Fee Schedule reduction. Attention Health Professionals: Information Regarding the Medicare Access and CHIP Reauthorization Act of 2015 On April 14 , 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015;…

Update on Medicare Physician Fee Schedule

As a result of the Congressional failure to yet adopt a “physician payment fix,” the Centers for Medicare & Medicaid Services (CMS) announced the efforts it will be taking beginning on April 15th, 2015 to alleviate the impact of the 21% decrease in payments required by current law. Meanwhile, CMS will be imposing a 10…

CMS Takes Action Against Aetna Inc. for Erroneously Identifying “Retail In-Network” Pharmacies

On April 2, 2015, CMS issued notice of imposition of a $1 Million civil money penalty (CMP) against Aetna for errors reported in Aetna’s pharmacy network directory. Due to this error, many Aetna enrollees presented prescriptions to their pharmacy, only to discover that the pharmacy was not in their plan. The Medicare enrollees complained to…

Another DOJ False Claims Act Settlement – Two Cardiovascular Disease Testing Labs to Pay $48.5M to Resolve Allegations of Kickbacks and Unnecessary Testing

The OIG has made it clear that laboratory payments to referring physicians are suspect as another False Claims Act (FCA) settlement was announced. The $48.5M settlement involves Health Diagnostics Laboratory, Inc. (HDL) and Singulex Inc. and resolves allegations they violated the FCA by paying remuneration to physicians in exchange for patient referrals and billing federal…

False Claims Act Update: Ohio Hospital to Pay $10M to Settle False Claims Allegations

Hospitals and physicians need to be alert when entering management agreements to ensure that the relationships require sufficient bonafide services to justify those management agreements. In this latest case, allegations related to violations of Stark Statute and Anti-Kickback Statute led to significant penalty payments, Ten Million Dollars. Hospitals and physicians need to ensure that any…

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