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Changes to Nursing Home Star Ratings Are Here

Beginning this month, the Centers for Medicare & Medicaid (CMS) is changing its star ratings on Nursing Home Compare and its Five-Star Quality Rating System, which allows consumers to compare quality between nursing homes. CMS says the updates “reflect more transparent and meaningful information about the quality of care that each nursing home is giving […]

Hospital Employees Fired for Celebrity Snooping

You’ve heard the saying “curiosity killed the cat,” well in the case of dozens of hospital employees, curiosity may have killed their careers. Earlier this month, Chicago’s Northwestern Memorial Hospital fired dozens of employees who allegedly accessed the medical records of actor Jussie Smollett without authorization, according to numerous published reports. The Empire actor was […]

OIG: Complimentary In-Home Care Permitted, Despite Potential Anti-Kickback Violation

A recent advisory opinion issued by the U.S. Department of Health and Human Services Office of the Inspector General has given a medical center the go-ahead to provide free in-home care to reduce re-admissions, despite a prohibition against giving patients handouts that might influence care decisions. The OIG advisory opinion is in response to a […]

Judge Rules United Behavioral Health Guidelines Led to Denial of Claims Violations

A California federal judge has issued a landmark ruling that could impact the way insurance companies cover mental health and substance use treatment. Chief Magistrate Judge Joseph Spero of the District Court for the Northern District of California ruled that United Behavioral Health (UBH) used “flawed” internal guidelines resulting in the unlawful denial of mental […]

CMS to Phase Out Split-Percentage Payments for New HHAs

Despite concerns from home health agencies (HHAs) that their cash flow could be significantly impacted, the Centers for Medicare & Medicaid (CMS) has announced that beginning in calendar year 2020 HHAs that are certified for participation in Medicare on or after January 1, 2019, will no longer receive split-percentage payments. Split-percentage payments allow a home […]

HIPAA Enforcement tops $28M in 2018

If it seems as if HIPAA violations were in the news more often than ever last year, that may be because 2018 saw an all-time record year in HIPAA enforcement activity. There were 10 cases settled and one judgement secured by the Office of Civil Rights (OCR) of the U.S. Department of Health and Human […]

Groundbreaking Rules for Electronic Health Records Proposed

The U.S. Department of Health and Human Services is proposing new rules that could pave the way for increased exchange of healthcare data by 2020. The rules, issued by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), would allow patients to have access […]

HHS Proposes Changes to Drug Rebate Safe Harbors

The U.S. Department of Health & Human Services (HHS) has issued a proposed rule that would amend the safe harbor regulation for certain drug rebates that manufacturers pay to pharmacy benefit managers (PBMs) Medicare Part D, and Medicaid managed care organizations (MCOs). Published in the Federal Register on February 6, the proposal is designed to […]

Lab to Pay $63.5M to Settle Kickback Allegations

Inform Diagnostics, an Irving, Texas-based pathology laboratory company, has agreed to pay $63.5 million to settle allegations that it violated the False Claims Act by engaging in improper financial relationships with referring physicians. The settlement stems from allegations that the company violated the Anti-Kickback Statute and the Stark Law by providing referring physicians with subsidies […]

OIG: Pediatric Clinic Can Provide Routine Cost-Sharing Waivers

A pediatric clinic that provides medical, psychiatric and dental care to low-income children can waive cost-sharing amounts for patients in financial need, even though the arrangement does not meet the regulatory exception for permitted waivers of cost-sharing amounts under the Civil Monetary Penalties Law, according to an Advisory Opinion issued by the Health and Human […]

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