On April 10, 2012, the GAO released a report (GAO-12-351) entitled Medicare Program Integrity – CMS Continues to strengthen the Screening of Providers and Suppliers. The report focusses on many of the ongoing Medicare program integrity initiatives that CMS has been implementing and that are required by the Patient Protection and Affordable Care Act (“PPACA”).
The GAO specifically looked at Medicare provider enrollment procedures. The GAO report focused on: (1) how CMS and its contractors use provider and supplier enrollment information to prevent improper payments and factors that may affect the usefulness of this information, and (2) the extent to which CMS has implemented new provider and supplier enrollment screening procedures since the enactment of PPACA. Continue reading
Posted in Certification, Compliance Programs, DHHS, Fraud and Abuse, Health & Human Services, Health Care, Health Care Providers, Health Reform, Medicare, Participation, Program Integrity, Provider Enrollment - Medicare, Regulatory Compliance, Reimbursement
On April 17, 2012, the U.S. Department of Health and Human Services announced that Phoenix Cardiac Surgery, P.C. agreed to a $100,000 settlement for the continuing failure of the covered entity from complying with the HIPAA Privacy and Security Rules. (HHS Press Release) The settlement also included the requirement of the implementation of an extensive corrective action plan to bring the covered entity into compliance with the HIPAA Privacy and Security Rules. The settlement came about after an investigation by the HHS Office of Civil Rights in response to a report it received related to the covered entity’s practice of posting protected health information on an Internet-based calendar accessible by the public. Continue reading
Frank Carsonie, Chair of our Health Care Practice Group, co-authored the article Reducing Risk in the Electronic Implementation of Electronic Records Systems: Practical Considerations and Benefits of a Risk Assessment in the March 2012 issue of HIT News published by the American Health Lawyer’s Association. Frank co-authorized the article with John DiMaggio, CEO of MCS2 Solutions, a veteran in the area of health care information technology solutions and privacy and security protections. The article provides a road map for organizations considering risk assessments for compliance with HIPAA and discusses some of the more common obstacles to completing a meaningful risk assessment and fully deploying a risk management plan.
The HIT Newsletter article* by Frank and John can be viewed here.
*Copyright 2012 American Health Lawyers Association, Washington, DC Reprint permission granted.
Posted in Consumers, DHHS, General, Health Care, Health Care Providers, Health Information Technology, HIPAA, Medicaid, Medicare, Patient Privacy, Regulatory Compliance
Lifewatch Services, Inc., an Illinois-based company, recently agreed to pay the United States $18.5 Million to resolve False Claims Act allegations filed by two separate whistleblowers. In addition to the settlement, Lifewatch entered into a comprehensive Corporate Integrity Agreement with the Office of Inspector General.
The whistleblower complaints alleged that Lifewatch improperly billed Medicare for ambulatory cardiac telemetry (“ACT”) services. Continue reading
Posted in Compliance Programs, Corporate Integrity Agreements, DHHS, Diagnostic Testing, Fraud and Abuse, Health & Human Services, Health Care, Medicare, Ohio, OIG, Program Integrity, Regulatory Compliance, Settlements, Washington