Category archive: General

Health Care Providers Beware – Overpayment Claim News

Two recently announced settlements with Washington State and the Federal government show two potential overpayment issues for providers. Molina Healthcare of Washington, Inc., announced in an SEC filing on September 5th, that it agreed in principle with the Washington Health Care Authority (HCA) to settle the two outstanding overpayment matters brought by HCA demanding recoupment…

CMS Offers to Settle Pending Appeals of Denied Claims

As a result of the substantial backlog of pending appeals for denied inpatient claims, Centers for Medicare & Medicaid Services (CMS) issued an offer to settle these denied claims in exchange for the hospitals withdrawal of pending appeals. Acute Care Hospitals and Critical Access Hospitals have until October 31, 2014 to make a settlement request….

EPA to Change Hazardous Pharmaceuticals Waste Management?

The Environmental Protection Agency (EPA) has proposed changes that may impact the way pharmaceuticals, especially those containing hazardous waste ingredients, are handled through reverse distribution. Organizations generating pharmaceutical waste including pharmaceutical companies, hospitals, long-term care facilities and physicians groups may be impacted. The following excerpt comes from the EPA website. Healthcare facilities and other business…

DOJ Files Suit Against Missouri Doctor For Anti-kickback Statute

The Justice Department is committed to combat fraud and abuse in federal healthcare programs. The most recent complaint filed by the DOJ is against Midwest Neurosurgeons LLC and its owner, Dr. Sanjay Fonn, MD, along with DS Medical LLC and its owner, Deborah Seeger. The defendants allegedly violated the Anti-Kickback Statute and False Claims Act…

Happy HIPAA update: OCR getting new Director

Based on reports that HHS Secretary Sylvia Mathews Burwell appointed Joceyln Samuels to replace Leon Rodriguez, it appears Office for Civil Rights (OCR) has the new leadership it has been awaiting. With this new leadership at the helm, can HIPAA audits be far off? Probably not. Iliana Peters, OCR’s senior advisor for HIPAA compliance and…

Learning the Hard Way – Omnicare to Pay $124M False Claims Settlement

False Claims Act (FCA) allegations are serious business. Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs. Omnicare learned the hard way just how serious FCA actions can be when a whistleblower made allegations against it. The Department of…

Happy HIPAA Monday – $800,000 Reason to Take HIPAA Seriously

Today, the HHS Press office released notice of a settlement of $800,000 with Parkview Health System, Inc. (Parkview) for potential HIPAA violations. This settlement relates to a complaint going back to September 2008, when Parkview received between 5,000-8,000 patient records from a retiring physician. Parkview received the medical records as part of the physician’s transition…

PHI + Home Computers = Possible Breach

Hershey Medical Center announced that it will notify 1,801 patients of a data breach. This privacy breach arose out of an employee’s action, which involved taking data home on a removable storage device to work on a personal computer at home after hours. The employee then used his personal email to send updated data to…

Nearly $5M Settlement for ePHI Breach Underlines Data Security Concerns

If you ever wonder if you should be concerned about HIPAA compliance, think about this latest Office of Civil Rights (OCR) settlement with New York Presbyterian Hospital (NYP) and Columbia University Medical Center (CU). Following a joint breach report on September 27, 2010, when NYP and CU disclosed the breach of electronic protected health information…

Affordable Care Act Update

The Department of Labor issued new FAQs about the Affordable Care Act, including updated model COBRA notices. Please see the following link: http://www.dol.gov/ebsa/faqs/faq-aca19.html. The updated model notices were issued as coverage options are now available in the Marketplace. Some qualified beneficiaries may want to consider and compare health coverage alternatives (such as the Marketplace) to…

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