As reported in the May 14th HLP blog, the Departments of Justice (DOJ) and Health and Human Services (HHS) recently released the Health Care Fraud and Abuse Control Program (HCFAC) Annual Report for Fiscal Year 2009, which reflects that $2.51 billion was deposited to the Medicare Trust Fund in 2009,…
On May 6, 2010 the Office of Inspector General (the “OIG”) posted Advisory Opinion 10-04, which approved a program conducted by several imaging centers to provide free pre-authorization services to patients and referring physicians (the “Pre-Authorization Arrangement”). This approval was somewhat unexpected in light of the OIG’s prior issuance of…
This month, the Office of Inspector General published its report of the activities and results of the Health Care Fraud and Abuse Control Program for 2009. A few highlights from the report include: 1014 new criminal health care investigations opened, 583 fraud-related convictions concluded, and $1.63 billion in judgments and…
Centers for Medicare and Medicaid published an interim final rule on May 5, 2010, that begins implementation of certain provisions of the Patient Protection and Affordable Care Act (PPACA) relating to Medicare and Medicaid program integrity. The regulations, with a comment period ending on July 6, 2010 (the effective date…
The Office of the Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) issued a report this month showing that program safeguard contractors (“PSCs”) have not resulted in significant recoveries to the Medicare program. PSCs are intended to detect and deter fraud and abuse in Medicare, by…
Compliance continues to be a hot topic given the continued increase in enforcement, audits and other aspects of health care reform. On May 7, 2010, the Office of Inspector General (OIG) posted on its website an excerpt from a keynote address that the Inspector General for the Department of Health…
On May 7, 2010, the Office of Civil Rights (OCR) issued guidance on the risk analysis requirement of the HIPAA Security Rule. Many providers have not paid close attention to the actual requirements of the HIPAA Security Rule. In addition to covered entity providers that must comply with the security…
On April 29, 2010, the U.S. Sentencing Commission issued new amendments to the standards for, and criteria included in, an “Effective Compliance and Ethics Program” in the Federal Sentencing Guidelines. These amendments have important implications for all corporate health care providers. For more information on corporate governance and effective compliance…
Despite efforts by the federal government to boost the ranks of primary-care physicians, an overwhelming number of physicians are choosing specialties other than internal medicine, and research has shown that internists leave the field mid-career at a much higher rate than other specialties. As a result, the shortage of primary-care…
The HIPAA Privacy rule currently provides the right of an individual to receive an “accounting of disclosures,” essentially a listing, of occurrences where a HIPAA covered entity has disclosed the individual’s information to others–but this rule has not considered disclosures made for treatment, payment, and health care operations information that…