In order to secure a new Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) contractor, the Centers for Medicare and Medicaid Services (CMS) has temporarily paused both Short Stay and Higher Weighted Diagnosis-Related Group (HWDRG) reviews. Previously, two BFCC-QIOs have performed HWDRG reviews since 2014 and Short Stay reviews…
As of April 30, 2019, the maximum penalties for violations of the Health Insurance Portability and Accountability Act (HIPAA) have new annual limits. These updated penalties will be based on the level of culpability associated with the violation, according to the Department of Health and Human Services (HHS). Organizations that…
The former CEO of a hospital chain that was headquarted in Naples, Florida has agreed to pay $3.46 million to settle allegations that he caused the hospital to knowingly submit false claims to government health care programs. Gary D. Newsome was the CEO of Health Management Associates (HMA) from September…
Following the December 2018 attempt of the U.S. Department of Justice (DOJ) to dismiss nearly a dozen False Claims Act (FCA) lawsuits, a recent ruling by Pennsylvania Federal Judge Timothy J. Savage states that the DOJ must have a legitimate reason for dismissing whistleblower suits. On Wednesday, April 3, 2019,…
For health care providers concerned about the effect the Covenant Medical Center v. State Farm ruling would have on their right to receive insurance payments for undisputed services, the University of Michigan Regents v. Victor P. Valentino, J.D. decision is a victory. The Michigan Supreme Court upheld the right of…
The U.S. Department of Health and Human Services (HHS) Office of Medicare Hearings and Appeals (OMHA) has taken steps towards implementation of its long-anticipated Electronic Case Adjudication and and Processing Environment (ECAPE). ECAPE is designed to function as an electronic case management and workflow system that includes the following operations:…
In her Federation of American Hospitals’ 2019 Public Policy Conference speech, CMS Administrator Seema Verma indicated the Stark Law would be receiving a major overhaul sometime in 2019. This update, according to Verma, will “represent the most significant changes to the Stark Law since its [1989] inception.” One of the…
HLP is proud to announce Robert S. Iwrey was recognized as a 2019 Leading Lawyer in Michigan for Health Law! This is a distinction that less than 5% of all lawyers licensed in Michigan receive. Please join us in congratulating Rob!
Maintaining compliance with all HIPAA Rules has never been more important for a health care business’s success than it is now. Last year, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) concluded an all-time record in Health Insurance Portability and Accountability Act…
Tomorrow, March 1, 2019, is the deadline for reporting small data breaches (<500) that occurred in calendar year 2018 to the Department of Health and Human Services’ Office for Civil Rights (OCR). Any HIPAA-covered entities and their business associates are required by the HIPAA Breach Notification Rule to, at least…