Heather Skelton will appear at the Employers Association Lunch & Learn on Tuesday, June 14, 2011 at 11:30 p.m. Heather will bring attendees up to date on recent changes in HIPAA pursuant to the HITECH Act, and on recent enforcement of the privacy rules. A question-and-answer period will be included.
To register, visit the Employers Association website.
May 13th, 2011
The North Carolina Senate Insurance Committee is currently considering Senate Bill 517. This bill would affect health care providers’ ability to freely negotiate reimbursement rates with insurance carriers, by prohibiting restrictive contract provisions.
This bill is of great interest to all providers of health care services. The full text of the bill can be found here.
To contact your senator regarding this bill, see this page on the NC General Assembly site.
May 11th, 2011
The testimony before the U.S. House of Representatives Committee on Oversight & Government Reform, Subcommittee on Health Care, District of Columbia, Census and the National Archives, of Gerald T. Roy, Deputy Inspector General for Investigations with the OIG, has been published and is available for review.
This testimony gives a perspective on Medicare and Medicaid fraud, waste and abuse from the point of view of an investigator who has been involved in pursuing and prosecuting fraud cases for almost twenty years, beginning with the efforts of the Clinton administration. He provides interesting insight into which means of Medicare fraud have changed over the years, especially with the expanding role of technology, and which means remain tried-and-true favorites.
Some insight is also given into how Medicare schemes are uncovered and investigated, as well as what remedial or punitive measures are taken. His testimony focuses on large corporate perpetrators and organized crime, rather than small private practitioners. Roy reports that efforts to curtail fraud and create increasing deterrents to its profitability have expanded in recent years, with admirable results; however, he also offers some ideas to prevent fraud up-front, such as strengthening requirements for becoming a participating provider and decreasing the response time to investigate possible fraud.
To read the entire transcript, see http://oig.hhs.gov/testimony/docs/2011/Roy_Testimony_04052011.pdf
April 26th, 2011
On March 31, 2011, HHS released proposed new rules that will help doctors, hospitals and other providers form Accountable Care Organizations (ACOs), and reward those ACOs that lower health care costs while meeting patient care standards. ACOs create incentives for health care providers to coordinate treatment of individual patients across care settings – including doctor’s offices, hospitals, and long-term care facilities.
Patient and provider participation in an ACO is purely voluntary. The delivery system reform, part of the Affordable Care Act, is expected to improve patient care and save the Medicare program as much as $960 million over three years. The proposed rules also include protections to ensure patients’s care choices are not limited by an ACO.
The proposed new rules will be finalized on January 1, 2012, but they are available for public comment for 60 days. HHS also announced it will hold a series of open-door forums and listening sessions during the comment period regarding what CMS, the agency administering the ACO program, is proposing to do and how to participate in the formal comment process.
For more information, read the fact sheet at www.HealthCare.gov/news/factsheets/accountablecare03312011a.html.
The proposed rule itself can be found at: http://edocket.access.gpo.gov/2011/2011-7884.htm
April 21st, 2011
On May 28, 2011, North Carolina’s Medicare Part B contractor will switch from CIGNA to Palmetto GBA, a subsidiary of Blue Cross Blue Shield of South Carolina.
Information for providers can be found here.
April 4th, 2011
On March 9, 2011, Inspector General Daniel R. Swinson testified before the U.S. Senate regarding the efforts of the Department of Health and Human Services and the Department of Justice to combat health care waste, fraud, and abuse, which cost U.S. taxpayers billions of dollars every year.
Inspector General Swinson testified that the OIG has opened more than 1,700 fraud investigations over the past fiscal year, resulting in over 900 criminal and civil actions and more than $3 billion in expected recovery.
Crimes covered by OIG investigations include billing for services that were never provided or were not medically necessary, misreporting costs to increase payments, paying or receiving kickbacks, and stealing the identities of providers or beneficiaries. Perpetrators of health care fraud range “from street criminals… to Fortune 500 companies…” Even organized crime has gotten into the game.
OIG’s work also includes auditing non-fraudulent errors in billing, coding, and documentation, which make up 10.5% of Medicare fee-for-service claims.
The collaboration between HHS and DOJ was born in the Health Care Fraud and Abuse Control program (HCFAC) established by HIPAA. Since 1997, HCFAC has returned over $18 billion of taxpayer money to the government; and the return on investment for the program has reached an all-time high of $6.80 returned for every dollar spent.
Click here for the full transcript of the testimony.
March 11th, 2011
HHS announced that General Hospital Corporation and Massachusetts General Physicians Organization Inc. (Mass General) will pay $1,000,000 in settlement of potential violations of HIPAA, and will sign a Resolution Agreement with HHS to develop and implement procedures and training to prevent possible violations of patients’ privacy in the future.
Mass General was extensively investigated by HHS after a patient reported their protected health information had been lost by the hospital. In the end, it was discovered that the protected health information of 192 patients had been lost when documents were left on a subway train by an employee. The documents were never recovered.
The full press release can be found here.
February 28th, 2011
The HHS Office of Civil Rights has imposed a Civil Money Penalty of $4.3 million on Cignet Health of Prince George’s County, Maryland, for violating the HIPAA Privacy Rule. This is the first time OCR has imposed a money penalty for violations of the Privacy Rule by a covered entity.
Cignet is accused of denying 41 patients access to their medical records, and of refusing to produce the records even upon demand by OCR during its investigation. HIPAA requires that patients’ medical records be produced within 30 days (and no later than 60 days) of the patient’s request.
The full press release can be read here.
February 23rd, 2011
The DOJ and HHS have announced the largest federal health care fraud takedown ever: The Medicare Fraud Strike Force has charged 111 people in nine cities, including health care providers and executives, with a total of over $225 million in fraud against Medicare.
The defendants are accused of conspiracy to defraud the Medicare program, false claims, kickback schemes, money laundering, and aggravated identity theft, all involving various medical treatments and services such as home health care, physical and occupational therapy, and medical equipment.
The Medicare Fraud Strike Force is a joint effort between DOJ and HHS which targets Medicare fraud through data analysis and community policing. Over the past two years, the force has expanded its efforts from two cities to nine, with the recent addition of Chicago and Dallas – representing a quadrupling of the number of strike force teams operating around the country.
For more information, see the full press release here.
February 21st, 2011
Twenty people, including three doctors, have been indicted on health care fraud, kickback and money laundering charges. The charges stem from a fraud scheme in which the individuals allegedly submitted over $200 million in false claims to Medicare for mental health services which were either medically unnecessary or not provided at all.
The defendants were all employed by or worked with American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc. Headquartered in Miami, ATC operates partial-hospitalization programs, an intensive form of treatment for mental illness, in seven locations throughout Florida. The defendants’ alleged fraudulent acts include manipulating the length of patients’ stays to maximize Medicare benefits and admitting patients with Alzheimer’s or extreme dementia who would not have benefited from the services provided. A lucrative kickback scheme and related money laundering operation are also included in the charges.
The full press release is available here.
February 18th, 2011
