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 York metropolitan area. Affinity filed […]
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 adverse peer review actions against […]
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 the fiscal year of 2013, […]
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. However, there is an in-office […]
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 and necessary. The report was […]
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 observation stays and short inpatient […]
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 settle allegations that it violated […]
On June 24, 2013, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) released Advisory opinion 13-07 regarding a proposed rebate program. The OIG ruled that the proposed arrangement would not generate prohibited remuneration under the Anti-Kickback Statute (“AKS”) because it qualified for safe harbor protection under the discount safe harbor, […]
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, and other health information were […]
Yesterday, CMS released a pre-publication proposed rule, Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule and Other Revisions to Part B for CY 2014 (2013-16547) (the “Proposed Rule”). Among other topics of interest, including proposed revisions to the EHR Incentive Program, the Proposed Rule contained significant proposed revisions related to […]
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