Physician Law Blog

Just a quick reminder - the Affordable Care Act enrollment deadline for 2015 is approaching. Sunday, February 15 is the last day to enroll in a health insurance plan for 2015. If one misses this deadline, they may not be able to get coverage until 2016. And while one may not get sick in 2015, if they don't have health insurance, they'll miss out on preventive care services and may pay a hefty fine when they file their federal income tax return next year.

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.

OCR issued an update regarding two important HIPAA settlements involving theft of unencrypted laptops. The first involved Concentra Health Systems report of a breach that an unencrypted laptop was stolen from the Springfield Missouri Physical Therapy Center. After concluding that Concentra had previously recognized its lack of encryption in multiple risk analyses, its efforts to protect patient PHI remained vulnerable due to incomplete and inconsistent encryption. As a result, Concentra agreed to pay OCR $1,725,220 to settle the violations and will be implementing a corrective action plan to remediate the findings.

Susan McAndrew, Office of Civil Rights deputy director for health information privacy spoke at the HIMSS Conference on 2/24/14. As the OCR already made known, it plans to resume its HIPAA compliance audit program this year following the Pilot HIPAA Audit program in 2012. Now, more information is available on the progress towards the start of those audits. Ms. McAndrew addressed the topic, noting that “hopefully in the coming months you’ll see actual activity that will start the audit process.”