Blog

Failure to Have Business Associates Agreement in Place Proves Costly

 A medical group practice based in Lakeland, Fla. must pay $500,000 to settle potential HIPAA violations and adopt a substantial corrective action plan after a data breach that could have affected more than 9,000 patients was discovered. According to the Office for Civil Rights of the U.S. Department of Health and Human Services, between November […]

Allergy Center’s HIPAA Fine Nothing to Sneeze at

A Connecticut healthcare provider recently learned it’s better not to comment in public about a patient, even if that patient has disclosed his or her own protected health information (PHI) to others. The incident involved Allergy Associates of Hartford, a provider specializing in the treatment of patients with allergies. The patient called a local television […]

Medicare Improper Payments Fall to Lowest Level in Eight Years

The Centers for Medicare & Medicaid Services (CMS) announced last week that its efforts to reduce improper payments is working. CMS noted that it paid out an estimated $31 billion in improper payments during fiscal year 2018, down from $36.2 billion a year earlier. That’s the lowest level since 2010. CMS noted this is the […]

Opioid Law Includes New Kickback Penalties for Drug Treatment Facilities/Labs

Last month, President Trump signed into law a bill designed to address matters relating to opioid use and abuse. Dubbed the “Support Act” an acronym for Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment, it includes a broad assortment of provisions to address the nation’s opioid crisis. One of the more significant provisions is […]

CMS 2019 Medicare Fee Schedule Designed to Reduce Administrative Burdens

The Centers for Medicare & Medicaid Services (CMS) has released its 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) rule, which the agency says will “address provider burnout and provide clinicians immediate relief from excessive paperwork tied to outdated billing practices.” However, a controversial payment component of the plan will be delayed […]

CMS to Draft Rule Requiring Prior Authorization for Chiropractors

Look for a proposed rule later this year that could make it harder for some chiropractors to submit Medicare claims. The Centers for Medicare & Medical Services is looking to require chiropractors with high rates of claim denials to obtain prior authorization before treating a patient. Chiropractors impacted will have to submit a request for […]

CMS Proposes Changes Designed to Speed up Medicare Appeals Process

It’s been a while since we last updated you on the latest about the Medicare appeals backlog, which although it has decreased some, remains troublesome. To further address the issue, The Centers for Medicare & Medicaid recently proposed revising its rules that govern the appeals process in an effort to further streamline it and reduce […]

Healthcare exec pleads guilty to multimillion-dollar opioid scheme

A Michigan healthcare CEO recently pleaded guilty to taking part in a $300 million healthcare fraud scheme that, in the words of U.S. Attorney Jeff Sessions, “flooded the streets” with millions of doses of opioids and other controlled substances. Mashiyat Rashid was CEO of the Tri-County Wellness Group of medical providers which operated pain clinics […]

OIG Unveils Fraud Risk Indicator

The Health and Human Services Office of Inspector General has launched a new initiative designed to draw attention to those healthcare providers it considers to be high risk for committing healthcare fraud after having been charged under the False Claims Act. The OIG posted this Fraud Risk Indicator on its website after Gregory Demske, the […]

Tis the Season: Gifts to Medicare Patients Nice Gesture or a Crime?

As we approach the holidays, now may be an appropriate time to point out the rules relating to gifts that providers can give to Medicare and Medicaid beneficiaries. During this time of the year, some healthcare professionals may want to give gifts to their patients, other physicians or even referral sources. Before you do, consider […]

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