Among other goals, federal health care reform strives to increase the public’s access to and coverage under affordable and meaningful health insurance. The Affordable Care Act (ACA) requires most U.S. Citizens and residents to have certain minimal health insurance coverage. The individual mandate–the imposition of a penalty upon certain individuals…
Under a settlement with the U.S. Department of Health and Human Services (HHS), Affinity Health Plan, Inc. will settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules for $1,215,780. Affinity Health Plan is a not-for-profit managed care plan serving the New…
On August 2, 2013, the Centers for Medicare & Medicaid Services (“CMS”) published its highly anticipated 2014 Inpatient Prospective Payment System (“IPPS”) Final Rule (the “2014 IPPS Final Rule”). The 2014 IPPS Final Rule will be effective on October 1, 2013. There are two main aspects of the 2014 IPPS…
The National Practitioner Data Bank (NPDB) issued a news release explaining why state record expungement is not a valid reason to void Data Bank reports. The NPDB is an electronic collection of all payments made on behalf of physicians in connection with medical liability settlements or judgments as well as…
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued its monthly Recovery Act Oversight report for June 2013. The report revealed that in June 2013, $16,937,121 of Recovery Act funds were used on Recovery Act activities. The report further indicated that to date in…
On Thursday, August 1, 2013, Congresswoman Jackie Speier (D-CA-14) introduced the “Promoting Integrity in Medicare Act of 2013 (PIMA) in the United States House of Representatives. As the law stands, Stark Law prohibits physicians from referring Medicare patients for certain health care services in which they have a financial interest.…
On August 5, 2013, the Department of Health and Human Services Office of Inspector General (OIG) released a report stating that Medicare received an estimated $38.2 million in prospective Part A inpatient hospital payments in calendar years 2009 and 2010 for short-stay, canceled elective surgery admissions that were not reasonable…
On July 29, 2013, the Department of Health and Human Services Office of Inspector General released a memorandum report titled Hospitals’ Use of Observation Stays and Short Inpatient Stays for Medicare Beneficiaries. The report was conducted in response to CMS and others who have raised concerns about hospitals’ use of…
On Monday, July 29, 2013, United States Attorney Carmen M. Ortiz and Susan J. Waddell, Special Agent in Charge of the Department of Health & Human Services, Office of Inspector General, announced that Beth Israel Deaconess Medical Center (BIDMC) has agreed to pay $5.3 million to the federal government to…
Due to violations of the privacy and security rules under HIPAA, WellPoint has agreed to pay a $1.7 million penalty to the United States Department of Health and Human Services (HHS). Between October 2009 and March 2010, personal information including names, dates of birth, addresses, Social Security numbers, telephone numbers,…