Tag Archives: Compliance

Red Flag Rules Compliance Required August 1, 2009

On August 1, 2009, health care providers will be subject to enforcement of the "Red Flag Rules" issued by the Federal Trade Commission under the Fair and Accurate Credit Transactions Act. The Red Flag Rules apply to health care providers who allow patients to pay for health care services, for example through co-payments and deductibles, … Continue Reading

President Signs Major Whistleblower Anti-Fraud Law

  Washington, D.C.  May 20, 2009.   Today President Barack Obama signed the Fraud Enforcement and Recovery Act of 2009.   The Act significantly expands protections for whistleblowers who expose fraud in federal contracting. This new law fixes problems in the False Claims Act, extends whistleblower protections to those who work for contractors and provides new funds … Continue Reading

Red Flag Rules Compliance Package

  On May 1, 2009, health care providers will be subject to the "Red Flag Rules" issued by the Federal Trade Commission under the Fair and Accurate Credit Transactions Act. The Red Flag Rules apply to health care providers who allow patients to pay for health care services, for example through co-payments and deductibles, in installments. … Continue Reading

OIG Open Letter Restricts Self-Disclosure Protocol

On March 24, 2009, the OIG issued an open letter (pdf) to healthcare providers restricting the application of the OIG Self-Disclosure Protocol (SDP).  The open letter states clearly that OIG is "narrowing the SDP’s scope regarding the physician’s self-referral law." This action has two components. First, the OIG will accept providers into the SDP only when … Continue Reading

FTC Settles Price-Fixing Cases Against Physician IPAs

It was the night before Christmas and all through the west, not a physician was conspiring, not even the next. . .  On December 24, 2008, the FTC announced settlement of price fixing cases against AllCare IPA, a 500 physician multi-specialty IPA organized as Independent Practice Associates Medical Group, Inc. in Modesto, California, and Boulder … Continue Reading


A New Jersey Court has awarded $400,000 to a deaf patient who claimed her doctor discriminated against her by refusing to provide an interpreter. Irma Gerena sued Robert Fogari, a Jersey City rheumatologist, under the Federal Americans With Disabilities Act and Rehabilitation Act, claiming violations for refusing to provide to interpreter. This is not a new issue. The … Continue Reading

Pennsylvania Medical Record Fees for 2009

On Saturday, December 6, 2008, Pennsylvania Secretary of Health published the allowable medical records fees under Pennsylvania Statute 42 P.A. C.S. §§ 6152-6155. Attached below is a link to the notice published in the Pennsylvania Bulletin. http://www.pabulletin.com/secure/data/vol38/38-51/2302.html    … Continue Reading

FTC Announces 6 Month Delay of Red Flag Rules

There has been some consternation whether the FTC Red Flag rules applied to medical practices as creditors. Organized medicine has been seeking clarification. which has not been forthcoming. Fortunately, this 6 month delay should allow somtime to review this issue. FTC Will Grant Six-Month Delay of Enforcement of ‘Red Flags’ Rule Requiring Creditors and Financial Institutions … Continue Reading

Reporting Practice Changes to CMS

  Once enrolled in the Medicare Program, physicians, other non-physician individual practitioners and physicians group practices are required to notify CMS of changes in their practice structures. These requirements are sometimes referred to as change in ownership (CHOW) rules. Physicians and other individuals are required to report the following on form CMS-855-I:   1.         Change of business … Continue Reading

HIPPA Administrative Simplification Proposed Rule

  On August 22, 2008 the Department of Health and Human Services published a Proposed Rule that would modify two of the medical data code set standards adopted in the Transactions and Code Sets final rule.  The Proposed Rule would modify the standard code sets for coding diagnoses and inpatient hospital procedures by concurrently adopting … Continue Reading

Peer Review Update: Adverse Peer Review Actions Require Independent Investigation

A California court has held that one hospital cannot take adverse peer review actions against a physician based solely on adverse peer review actions at another hospital; there must be an independent investigation of the medical issues. In Smith vs. Selma Community Hospital, a copy of the opinion is attached below, the California appellate court … Continue Reading

Congress Overrides Medicare Veto

Congress Overrides Medicare Veto The House voted 383 to 41 to override the veto, while the Senate voted 70 to 26, in both cases far more than the two-thirds necessary to block the president’s action. With organized medicine and other lobbies promoting the popular measure in an election year, Republicans broke heavily from the White … Continue Reading

Monitor Your Billing Company’s Collection Practices

Collection Notices Must Interpreted From The Point Of View Of The “Least Sophisticated Debtor” The U.S. District Court for the Middle District of Pennsylvania has reinforced that collection notices must be interpreted from the point of view of the “least sophisticated debtor.” Under the Fair Debt Collection Practices Act, 15 U.S.C. § 1692 (FDPCA), the … Continue Reading

Pennsylvania State Board Of Physical Therapy

Prior to legislation adopted in 2001, the Pennsylvania State Board of Physical Therapy regulated athletic trainers. Under Acts 92 and 93, the regulations promulgated pursuant to the Pennsylvania Physical Therapy Practice Act were to continue to govern the activities of athletic trainers until the State Boards of Medicine and Osteopathic Medicine adopted Final-Form Regulations. These Final-Form Regulations … Continue Reading

Form 990 Redesign For Tax Year 2008

Form 990 Redesign for Tax Year 2008 The IRS currently requires every charitable organization, and every similar tax-exempt organization, with gross receipts of at least $100,000 or assets of at least $250,000 to file an annual return on Form 990. On December 20, 2007, the IRS published major changes to its Form 990. Certain of the changes … Continue Reading

CMS Seeks Gainsharing Comments or Suggestions

Gainsharing is generally defined as an arrangement between physicians and hospitals to share cost reductions, which can be narrowly targeted projects such as standardization of hospital equipment and supplies or broadly targeted projects such as average cost per case. Gainsharing is an attempt to align financial incentives in an environment where the existing incentives are actually … Continue Reading

Good Summary of NPI from CMS

The NPI is here.  The NPI is now.  Are you using it? Industry-Wide Enforcement of the NPI Compliance Date  The compliance date for the NPI for all HIPAA covered entities except small health plans was May 23, 2007.  (Small health plans have until May 23, 2008 to comply.)  In guidance provided on April 2, 2007, … Continue Reading

Bloodborne Pathogen Standard Compliance Resources

During the period of October 2005 through September 2006, doctors’ offices received 156 citations for bloodborne pathogen violations resulting in $51,064 in fines. (http://www.osha.gov). Additionally, during that same period general medical and surgical hospitals received 118 citations while nursing care facilities received 344 citations (http://www.osha.gov). … Continue Reading

Illinois Attorney General Charges Physician Groups with Price Fixing for Medicaid Patient Boycott

The Illinois Attorney General has filed price fixing charges against the two largest physician groups in Champaign County, Illinois, charging them with boycotting Medicaid patients in order to raise prices. Carle Clinic Associates, P.C. has 300 physicians, 200 of which are in Champaign County, Illinois, representing a 60% market share. Christie Clinic, P.C. has 100 physicians, all … Continue Reading

IRS Issues Directive Clarifying Tax Impact of EHR Subsidies on Tax Exempt Status

The Internal Revenue Service issued a directive on May 11, 2007 confirming that the provision of hardware and software components of electronic health records (EHR) will not constitute private inurement jeopardizing the tax exempt status of non-profit hospitals. This directive is another step forward in facilitating hospital subsidized EHR for private practice physicians. The Centers for … Continue Reading