Pioneer Accountable Care Organizations succeed in improving care, lowering costs

CMS press release announcing first year performance results from the Pioneer ACO program. Cost saving results are mixed, but CMS is touting that all 32 Pioneer ACOs that participated report success with quality metrics.

Read the entire press release here.

July 19th, 2013

Cedars-Sinai Fires Six Over Patient Privacy Breaches After Kardashian Gives Birth

Cedars-Sinai Medical Center, Los Angeles, has fired five workers and a student research assistant for peeping on patients’ private medical records in the days after reality television star Kim Kardashian gave birth to her daughter there.

Three physicians violated hospital policy by giving underlings their hospital log-on, information that was abused to access confidential patient records, according to the hospital.

Five of the fired workers looked at one record, and one worker looked at 14 records.

Read the entire article here.

July 18th, 2013

Shasta Regional Medical Center Settles HIPAA Security Case for $275,000

Shasta Regional Medical Center (SRMC) has agreed to a comprehensive corrective action plan to settle an investigation by the U.S. Department of Health and Human Services (HHS) about potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and will pay a $275,000 monetary settlement.

The HHS Office for Civil Rights (OCR) opened a compliance review of SRMC following a Los Angeles Times article which indicated two SRMC senior leaders had met with media to discuss medical services provided to a patient. OCR’s investigation indicated that SRMC failed to safeguard the patient’s protected health information (PHI) from impermissible disclosure by intentionally disclosing PHI to multiple media outlets on at least three separate occasions, without a valid written authorization. OCR’s review indicated that senior management at SRMC impermissibly shared details about the patient’s medical condition, diagnosis and treatment in an email to the entire workforce. Further, SRMC failed to sanction its workforce members for impermissibly disclosing the patient’s records pursuant to its internal sanctions policy.

In addition to the $275,000 monetary settlement, a corrective action plan (CAP) requires SRMC to update its policies and procedures on safeguarding PHI from impermissible uses and disclosures and to train its workforce members. The CAP also requires fifteen other hospitals or medical centers under the same ownership or operational control as SRMC to attest to their understanding of permissible uses and disclosures of PHI, including disclosures to the media.

Read the Press Release here.

Read the Resolution Agreement here.

June 21st, 2013

FREE Omnibus HIPAA/HITECH Final Rule Summer Webinar Series

Friday, June 14 – Friday, July 26, 2013
1:00pm – 2:30 PM ET
Dial In From Any Location!

Learn more here.

Register here.

May 16th, 2013

Charlotte Woman Pleads Guilty to $4.8 Million Medicaid Scheme, Aggravated Identity Theft, and Other Charges

A Charlotte woman pleaded guilty in U.S. District Court for her involvement in a health care fraud scheme that attempted to defraud Medicaid of $4.8 million for sham mental and behavioral health services.

Read the entire article here.

April 26th, 2013

Charlotte Neurologist Will Pay $2 Million To Settle Civil Fraud Allegations

A Charlotte neurologist has agreed to pay $2 million plus interest to the United States to settle civil fraud allegations. Hemanth P. Rao, MD, is the owner of and principal neurologist at The Neurological Institute in Charlotte. The settlement was reached following a multi-year investigation by HHS-OIG into Dr. Rao’s practices associated with the administration of intravenous immunoglobulin (IVIG) therapy. Government investigators found that Dr. Rao failed to meet the Medicare supervision regulations associated with IVIG therapy. Dr. Rao has since entered into a five-year Integrity Agreement with HHS-OIG to promote compliance with the statutes, regulations, program requirements, and written directives of Medicare, Medicaid, and all other federal health care programs.

Read the entire article here.

April 24th, 2013

OIG’s Provider Self-Disclosure Protocol Update

Providers who wish to voluntarily disclose self-discovered evidence of potential fraud to OIG may do so under the Provider Self-Disclosure Protocol (SDP). Self-disclosure gives providers the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.

Since SDP’s original publication in 1998, we identified areas where additional guidance would be beneficial to the health care community and would improve the efficient resolution of SDP matters. To that end, we issued three Open Letters to Health Care Providers in 2006, 2008, and 2009.

Since the last Open Letter, we continued to evaluate our SDP process. We also solicited comments about the SDP on June 18, 2012, and we received numerous helpful comments from the public. On the basis of our experience and the comments we received, we have decided to revise the SDP in its entirety at this time.

View the Updated SDP here.

April 17th, 2013

HIPAA Administrative Simplification Frequently Asked Questions

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that additions to the Frequently Asked Questions (FAQS) on HIPAA Administrative Simplification are now available on the CMS website.

The purpose of the FAQs is to provide detailed answers to common questions regarding Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification such as what is meant by “certification of compliance” with HIPAA operating rules and standards; and do the HIPAA transaction requirements, including the operating rules, apply to transactions between a health plan and its policyholders.

These and many other FAQs may be found on the Frequently Asked Questions webpage on the CMS website.

April 15th, 2013

CMS Can Withhold Medicare Payments To Pay Off Pre-Bankruptcy Overpayments

A medical provider’s Medicare claims filed with the Centers for Medicare & Medicaid Services after a bankruptcy filing can be used to recoup overpayments from claims paid to the provider prior to bankruptcy, according to a March 22 federal court ruling in South Carolina (Fischbach v. Centers for Medicare and Medicaid Services (In re Fischbach), D.S.C., No. 1:12-cv-513, 3/22/13).

Judge J. Michelle Childs’s ruling for the U.S. District Court for the District of South Carolina held that a Medicare provider’s continuing stream of claims and payments from CMS represent a single transaction under Chapter 7 of the U.S. Bankruptcy Code and are not subject to the automatic stay provision of a bankruptcy filing.

Read the entire article here.

April 12th, 2013

CMS Changes Course on 2014 MA Rates, Announces Hike of More Than 3 Percent

In a reversal of policy, the Centers for Medicare & Medicaid Services April 1 said it will assume that Congress will override an impending cut in Medicare physician payment in 2014 and announced that Medicare Advantage rates will increase by more than 3 percent in 2014, rather than decline by more than 2 percent as had been proposed.

Read entire article here.

April 10th, 2013

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