Month: April 2017

New Guide Helps Measure Compliance Program Effectiveness

New Guide Helps Measure Compliance Program Effectiveness The Department of Health and Human Services’ Office of the Inspector General (“OIG”) has long championed the need for health care organizations to implement their own “effective” compliance programs as a way to avoid or mitigate HIPAA and fraud and abuse violations. But what exactly constitutes an “effective” compliance program? How does OIG go about measuring effectiveness? Thanks to a March 27, 2017 joint release between OIG and the Health Care Compliance Association (“HCCA”), health care organizations may now have the means to judge for themselves whether they have implemented an effective...

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Recent Settlement of Alleged HIPAA Violations Demonstrates HHS’s Intent to Protect Both Patients and Healthcare Providers

Recent Settlement of Alleged HIPAA Violations Demonstrates HHS’s Intent to Protect Both Patients and Healthcare Providers The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) harbors within it the Privacy and Security Rules, which lay down the law for the proper protection and accessibility of electronic protected health information (“ePHI”). Since HIPAA’s enactment, it is not uncommon in the healthcare sphere to hear of HIPAA violations or settlements resulting in a federally-qualified health center (“FQHC”) paying out millions of dollars because of inadequate privacy or security. However, one would be remiss in thinking that the HHS Office of...

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Article of the Week: Physicians Falling Victim to Bribery

Article of the Week: Physicians Falling victim to Bribery Though practicing physicians should be familiar with the False Claims Act, the Anti-Kickback Statute, and the Stark Law, this recent article from The Washington Post suggests that the type of conduct these laws and regulations prohibit may not always be addressed by medical schools to their students. This article gives a brief narrative of Michele Martinho, an internist who practiced in New York before pleading guilty to one count of accepting a bribe in 2014. This bribe came in the form of monthly cash payments from a New Jersey laboratory...

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Anti-Kickback Issues Continue For Prominent Hospital Chain

Anti-Kickback Issues Continue For Prominent Hospital Chain   Fresh off a $513 million settlement in October 2016 of both criminal and civil causes of action, Tenet Healthcare Corporation is back in the spotlight for unflattering reasons. The 2016 settlement stemmed from a False Claims Act (“FCA”) suit centering on alleged kickbacks from referrals of obstetrical patients. Those former obstetrical patients of Tenet and its subsidiaries recently filed a federal class-action suit in Georgia federal court alleging fraud, negligent misrepresentation, and other state law claims left unresolved by the settlement of the federal Anti-Kickback claims.   The alleged scheme in...

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