Ever wonder if the Office of Civil Rights (“OCR”) is serious about the requirements for a HIPAA Security risk analysis and policy specific to removing hardware and electronic media containing ePHI from a covered entity’s facility? Yes, the OCR is extremely serious about those requirements as Cancer Care Group, P.C. (“Cancer Care”), a radiation oncology private practice, with 13 radiation oncologists discovered after reporting a breach of ePHI.
We provide insights and analysis for physicians, nurses, chiropractors, dentists, physical therapists and other health professionals on issues impacting their practices.
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 second Office of Medicare Hearings and Appeals (OMHA) Medicare Appellant Forum will take place tomorrow, October 29, 2014 from 10 am to 3 pm EST. OMHA is working to provide updates on the backlog of appeals of denied claims, and its initiatives to mitigate the backlog of claims. Recently, CMS offered a settlement option for certain providers for denied claims on appeal as a way to reduce the appeal backlog.
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).
The Department of Justice announced a False Claims Act settlement where Amedisys agreed to pay $150 million and will be bound by a Corporate Integrity Agreement as a result of alleged improper financial relationships and false billing. The settlement resolves seven qui tam (whistleblower) lawsuits brought primarily from former Amedisys employees. The whistleblowers will collectively split over $26 million from the settlement. Among the claims alleged were that Amedisys billed Medicare for services to ineligible patients by misrepresenting patients’ conditions to increase its Medicare billings as well as maintaining improper relationships with referring physicians. This settlement is an achievement for HEAT, the Health Care Fraud Prevention and Enforcement Action Team initiative announced in 2009, which continues to combat health care fraud having recovered more than $19.2 billion through False Claims Act cases, with more than $13.6 billion recovered in cases involving fraud against federal health care programs.