Most healthcare providers understand that routinely waiving patient cost-sharing obligations creates compliance issues under the Anti-Kickback Statute, the Civil Monetary Penalties Law, and third-party payor agreements which...more
One of the fundamental compliance requirements for healthcare providers is protecting the confidentiality and security of the patient health information you maintain. Most healthcare providers are subject to a federal law...more
Has a patient asked you or one of your providers if they could record a conversation or interaction with you? Would your staff know how to handle such a request? Requests from patients and their families to record...more
One of the biggest changes in healthcare over the past 15 years has been the move to electronic medical records. In 2009, only 12% of hospitals and 22% of physician practices utilized a certified electronic health record. As...more
We talk frequently on the podcast about how important it is for providers to find compliance issues early so they can correct them and self-report if needed. One way to find compliance issues early is for your employees and...more
In the wake of the United States Supreme Court’s decision in U.S. ex rel. Schutte v. SuperValue, Inc., interpreting the False Claims Act’s scienter element – referring to the defendant’s knowledge and subjective beliefs –...more
Lack of transportation can be a significant barrier to accessing healthcare services. According to a Robert Wood Johnson Foundation report, one in five patients report forgoing needed healthcare services due to lack of...more
We are halfway through 2024, which means: now is the perfect time to evaluate your 2024 compliance initiatives and assess how you’re doing! It’s time to give your compliance work plan a 6-month check-up....more
There has been much publicity surrounding the Centers for Medicare and Medicaid Services’ (“CMS”) new minimum staffing requirements for long-term care facilities scheduled to take effect starting in 2026 for non-rural...more
The healthcare industry remains a popular target for ransomware attacks. If you haven’t been impacted by a ransomware attack, it’s likely only a matter of time before someone you do business with or buy services from is...more
6/10/2024
/ Business Associates ,
Cyber Attacks ,
Cybersecurity ,
Data Breach ,
Data Security ,
Hackers ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Information Technology ,
Popular ,
Ransomware
Does your compliance program incorporate quality and patient safety issues? Or, are you treating the two areas as separate and distinct departments? The OIG’s General Compliance Program Guidance recommends all healthcare...more
Every day, new articles extol the benefits of artificial intelligence (AI) within the healthcare industry. If you aren’t already using generative AI tools, it’s likely only a matter of time....more
At the Health Care Compliance Association’s recent Annual Compliance Institute in Nashville, artificial intelligence (AI) dominated the conversation.
A common theme: how does the compliance officer keep pace with this...more
5/13/2024
/ Artificial Intelligence ,
Compliance Management Systems ,
Electronic Medical Records ,
Employee Handbooks ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Innovative Technology ,
Machine Learning ,
Patient Safety ,
PHI ,
Policies and Procedures ,
Risk Assessment
Audits are an important part of a compliance program and help monitor compliance obligations, identify non-compliance, and quantify overpayments. But, planning the audit is often just as important as the audit itself. One of...more
Compliance is a “team effort.” Everyone in the organization has an important role to play. It’s critical, however, that each member of the team understand their specific role and how it relates to compliance. Compliance...more
The most successful compliance programs are constantly evolving and always in motion. They are both action-oriented and flexible. How do you build a program that’s action-oriented and flexible? You implement a detailed work...more
Most healthcare providers understand the importance of having a designated Compliance Officer. Someone needs to lead the organization’s compliance initiatives and be responsible for advising the CEO and governing body of...more
Sometimes we forget that even small and medium-sized providers can run afoul of antitrust laws and regulations. Often these activities are well-intentioned. It’s not uncommon for competing providers to want to work together...more
The compliance officer is one of the most important positions within the organization, but also one of the most challenging. You’re expected to be a teacher, a coach, a project manager, a good listener, and a role model....more
Healthcare providers, their employees, medical staff, and patients have long been protected by Federal conscience protections preserving their right to participate in, or refuse to participate in, lawful activities which may...more
Fiscal year 2023 saw record recoveries and the highest number of settlements and judgments ever under the Federal False Claims Act. According to a new report released by the United States Department of Justice (“DOJ”), the...more
3/4/2024
/ Anti-Kickback Statute ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Final Judgment ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Fraud ,
Qui Tam ,
Regulatory Violations ,
Settlement ,
Whistleblowers
Fiscal year 2023 saw record recoveries and the highest number of settlements and judgments ever under the Federal False Claims Act. According to a new report released by the United States Department of Justice (“DOJ”), the...more
Diabetes and obesity drugs have skyrocketed in popularity as of late. According to a report released by Trilliant Health in September 2023, healthcare providers in the United States wrote more than 9 million prescriptions for...more
In November 2023, the United States Health & Human Services Officer of Inspector General (“OIG”) issued new compliance program guidance for the healthcare industry, referred to as the General Compliance Program Guidance...more
Is your organization’s culture complimenting your healthcare compliance program? Does it enhance and maximize your program’s effectiveness? Or, is your culture secretly sabotaging your compliance efforts?...more