Tag archive: hospitals

HIPAA Update – Newest Settlement of $475,000 Results From Untimely Breach Report

Don’t let your clients get caught paying a “big” settlement for failing to report a HIPAA breach! For the first time, the Office of Civil Rights (OCR) has announced a HIPAA settlement with a provider who failed to provide a timely breach report. Presence Health, a health network serving Illinois with approximately 150 locations, including…

Beware of Low Hanging Fruit – OIG Targets for Fraud and Abuse

On June 18, 2015, the US Attorney announced two investigations resulting in a number of accusations of Medicare and Medicaid fraud and abuse. The “Home Alone IV” take-down and the largest national health care fraud take-down to date involving more than 200 subjects accused of defrauding Medicare and Medicaid of more than $700 Million in…

New Risk for Hospitals – CMS Proposes Bundled Payments for Hip & Knee Replacement Surgeries

Building upon the bundled payment demonstration programs currently underway for Medicare, the Centers for Medicare and Medicaid Services (CMS) announced a proposal for a major shift in the way hospitals will be paid for hip and knee replacements. In an effort to incentivize hospitals to encourage quality and care improvements as patients transition from surgery…

False Claims Act Update – 16 Hospitals to Pay $15.69M Related to Medically Unnecessary Psychotherapy Services

On May 7, 2015, the Department of Justice reported settlement with 16 separate hospitals for medically unnecessary or unreasonable psychotherapy services. The claims under scrutiny were Intensive Outpatient Psychotherapy (IOP) services, which represent a variety of treatment methods. The services, while billed to Medicare by the providers, were performed on the providers’ behalf by Allegiance…

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…

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…


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