The first criminal HIPAA verdict was entered in January of 2007, and HIPAA privacy rule enforcement statistics were reported at the 14th National HIPPA Summit.
In U.S. v. Ferrer, in the Cleveland Clinic case, a Florida jury found the Defendant, Mr. Fernando Ferrer, Jr. guilty of one count of wrongful disclosure of individually…
There has been an explosion in the Qui Tam litigation in the healthcare industry, as well as other industries dependent upon government payment. Qui Tam litigation allows private parties, frequently disgruntled employees (and more frequently disgruntled ex-employees) or competitors to file suit to recover damages on behalf of the government. The complaints are filed under seal and…
Coincidentally, just a few days after the Office of Inspector General announced the $3 million settlement of the credit balance case with the Tennessee cardiology practice, Highmark Medicare Services issued a bulletin reminding providers of their obligation to file the Medicare Credit Balance Detail Report 838. Let me remind you that part of the basis…
Pennsylvania allows health care facilities or health care providers to charge fees for the reproduction of medical records. Below is the exact text of the announcement in the
December 2, 2006 Pennsylvania Bulletin (Vol. 36, No. 48, pages 7345 and 7346) announcing the approved fees for 2007:
Under 42 Pa. C.S. § § 6152 and 6155…
Senator Bill Frist has launched a new healthcare Blog. MedicalMatter.org: a21st Century Discussion of Health Care Issues. According to the inaugural post, the blog is about "healthcare and the politics of healthcare", and will address issues such as electronic health records (EHR), stem cell research, health savings accounts (HSA), and many other topics.
REGARDING SPECIALTY HOSPITALS
The Secretary of Health and Human Services, Michael O. Leavitt, has submitted an interim report to Congress entitled “Development of a Strategic Plan Regarding Physician Investment and Specialty Hospitals,” as required by Deficit Reduction Act of 2005 (DRA). HHS was required to develop and implement a strategic plan concerning whether physician investments…
The Centers for Medicare and Medicaid Services (CMS) has posted new and revised versions of its provider/suppliers/practitioner Medicare enrollment forms (855s). These new forms were issued immediately after the final regulations defining the requirements of the enrollment process were published on April 21, 2006, as noted April 27, 2006 on the Med Law Blog. The revised forms are effective April 30, 2006. The CMS forms emphasize that the application process should be directed through the appropriate physical intermediary (FI) or carrier, rather than CMS.
Continue Reading CMS POSTS NEW MEDICARE PROVIDER ENROLLMENT FORMS ON WEBSITE
On August 24, 2006, the Office of Inspector General issued an Open Letter to healthcare providers encouraging self-disclosure of violations of the federal healthcare programs.
Continue Reading OIG Encourages Self-Disclosure of Hospital/Physicians Stark Relationships
We have noticed significantly increased post-payment review audit activities on behalf of Highmark and HGSAdministrators, the Medicare side of Highmark.
When records are requested, it is critical that you do not respond cavalierly. The records you initially supply will be used to determine whether you will be subject to a refund request and further review.
If you have not been involved in this type of audit activity before, you should experienced counsel to assist you with your response. The potential for extrapolated refund requests is a serious threat.
Continue Reading Medicare And Highmark Audit Activities
Robert Wood Johnson Foundation has completed “The Synthesis Project,” which is a project summarizing certain research on hospital consolidation over the last decade. Although the report qualifies its conclusion, the Synthesis Project suggests that hospital mergers increase prices, decrease quality and were only anecdotally related to the increase in managed care. The report is available…
