Massive Spike in FCA Penalties

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In November 2015, the Bipartisan Budget Act of 2015 went into effect. One aspect of that act was the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015. The new law required that the Program Fraud Civil Remedies Act and the False Claims Act (“FCA”) penalties be “corrected” to adjust... Continue Reading →



Medicare Releases Proposed Rule for Physician Payment Overhaul

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On April 27, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released a much anticipated proposed rule (“Proposed Rule”) for the transition to a new Merit-Based Incentive Payment System (“MIPS”) and alternative payment models (“APMs”) pursuant to the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015... Continue Reading →

HIPAA on the Small Screen: OCR Penalizes Unauthorized Patient Filming

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On April 21, 2016, the Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced a $2.2 million settlement with a New York hospital (“Hospital”) stemming from unauthorized patient filming by ABC’s NY Med television show. In what OCR called an egregious disclosure of protected health information... Continue Reading →

The Medicare Chess Game: New Moves for Some Urban Hospitals

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In an interim final rule published in the Federal Register on April 21 (“Rule”), the Centers for Medicare & Medicaid Services (“CMS”) amended its regulations to allow PPS hospitals located in urban areas to obtain a “412.103” urban to rural reclassification and also be reclassified for wage index purposes by... Continue Reading →

CMS’s New Medicaid Managed Care Rule Provides a Temporary Substitute for Upper Payment Limit Payments and Other Supplemental Payments

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On May 6, 2016, CMS will publish its new Medicaid managed care rule, which will permit states to require Medicaid MCOs1 to make enhanced payments to targeted hospitals, physicians and nursing facilities for a limited number of years. This is a departure from current practice in which states are prohibited... Continue Reading →

Business Associate Agreements Are Critical to HIPAA Compliance: OCR Announces $755,000 Settlement Action

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On April 19, 2016, the U.S. Department of Health and Human Services Office for Civil Rights (“OCR”) reached a settlement in the amount of $755,000 with a North Carolina orthopedic clinic (“Clinic”) for failing to execute a business associate agreement with a third-party vendor. This is OCR’s second settlement this... Continue Reading →