Author archive: physicianlaw

HIPAA Update – Advocate Health Care, a Single entity, settles HIPAA Penalties for $5.55 Million

Advocate Health Care Network, the largest fully-integrated health care system in Illinois, agreed to the largest HIPAA Settlement to be paid by a single entity for potential penalties in the amount of $5.55M. The alleged long term non-compliance resulting in this settlement included four failures to comply with HIPAA including: failure to adequately conduct risk…

Fraud and Abuse Update: Inflation Adjusted Rate Hikes Coming Aug. 1 for False Claim Act and Anti-Kickback Civil Money Penalties

PROVIDERS TAKE NOTE: CIVIL MONEY PENALTIES FOR FALSE CLAIM ACT AND ANTI-KICKBACK STATUTE VIOLATIONS WILL NEARLY DOUBLE AUGUST 1ST The Department of Justice (DOJ) released an interim final rule recently to update the minimum and maximum civil money penalties (CMP) for violation of the False Claim Act (FCA). Providers should be aware that the increases…

HIPPA’s Not Just For Covered Entities – Recent Enforcement Action Extends To Business Associates

On June 29, 2016, the Office of Civil Rights (OCR) announced a Resolution Agreement it entered with Catholic Health Care Services of the Archdiocese of Philadelphia (CHCS) a business associate of six nursing homes. This Resolution Agreement included a monetary payment of $650,000 and a Corrective Action Plan (CAP). The CAP requires CHCS to conduct…

Massive National Health Care Fraud Takedown

Last week, the OIG reported charges against 301 individuals for approximately $900 Million in false billing as part of the largest false claim takedown. The takedown focused on a broad range of providers including home health companies, physicians, physical and occupational therapy clinics, infusion clinics, mental health providers, DME suppliers, and compounding pharmacies. Of importance,…

Hospital Alert – Medicare Update Mandates the Use of Modifier JW for Billing Discarded Drug Waste

Discarded pharmaceuticals and the high cost of drugs continue to receive attention in the news, as well as from the Centers for Medicare and Medicaid Services (CMS). In response to these concerns, CMS recently issued a mandate updating the use by hospitals of the JW modifier to document discarded drugs or biologicals in patient’s medical…

Non-Economic Damage Caps Remain Constitutional in Wrongful Death Actions

On April 19, 2016, the Missouri Supreme Court issued its opinion in James Dodson, et al. v. Robert Ferrara, M.D., et al. The Court upheld Missouri’s 2005 “tort reform” non-economic damage cap as constitutional as applied in wrongful death cases. Basic Facts and Litigation History: On February 8, 2011, Shannon Dodson presented to the Mercy…

Hiring Excluded Healthcare Employees is a Costly Mistake

The Office of the Inspector General (OIG) released its report of Provider Self-Disclosure Settlements for the first quarter of 2016. During the first three months of 2016, the OIG reports that 8 health care providers self-reported employing individuals that the employer knew or should have known were excluded from participation in Federal health care programs….

Another HIPAA Settlement – $1.55 Million Following Unencrypted Laptop Theft

$1.55 Million Settlement focuses on HIPAA requiring Business Associate Agreements North Memorial Health Care of Minnesota entered a settlement to pay $1.55 Million resulting from allegations that it violated HIPAA for failing to enter a business associate agreement (BAA) to address risks and vulnerabilities to its patient information. In the Office for Civil Rights (OCR)…

CMS Issues Proposed Rule to Overhaul Part B Drug Payments

The Centers for Medicare and Medicaid Services (CMS) has released a new proposed rule to reduce Medicare expenditures by changing the way it makes payments for Part B drugs. The proposal includes two phases. The first involves changing the percent of add-on to the Average Sales Price (ASP) of the drugs from 6% to 2.5%…

REMINDER: PHI Breaches Affecting Less than 500 Individuals Must Be Reported to HHS by 2/29/16

The annual reporting deadline for any breaches of unsecured protected health information (PHI) affecting fewer than 500 individuals is quickly approaching. HIPAA requires all covered entities to notify Office of Civil Rights (OCR) regarding a breach of unsecured PHI affecting fewer than 500 individuals within 60 days of the end of the calendar year. These…

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