News & Analysis as of

OCR to Begin Phase 2 of HIPAA Audit Program

The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) will soon begin a second phase of audits (Phase 2 Audits) of compliance with Health Insurance Portability and Accountability Act of 1996 (HIPAA)...more

Are your HIPAA ducks in a row? The next round of OCR HIPAA audits is approaching

In 2011 the Department of Health and Human Services’ Office for Civil Rights (OCR) established the HIPAA Pilot Audit Program to ensure compliance with HIPAA’s privacy, security and breach notification rules. The first...more

Got A Complaint About RAC Audits? Get In Line

Criticism of the RAC (recovery audit contractor) program is becoming a national pastime. Needless to say, hospitals hated the program from the very beginning. And little wonder. The program pays private contractors a...more

Health Law Alert: HIPAA Enforcement on the Rise, as OCR Audit Program Moves Forward

A recent settlement from New York—involving the largest fine levied to date in the history of HIPAA enforcement, a staggering $4.8 million imposed on two public hospitals—should remind health care providers, health plans and...more

Policyholders Face Heightened Scrutiny Under OCR’s New Permanent Audit Program

The U.S. Department of Health and Human Services’ Office for Civil Rights (“OCR”) has notably increased enforcement of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”) and Health Information...more

Coming Fall 2014: HHS Launches Permanent Audit Program

Beginning in the Fall of 2014, a substantial number of covered entities and business associates will receive a notification and data request from the Health and Human Services' (HHS) Office for Civil Rights (OCR). According...more

OCR Releases Information on What Phase 2 HIPAA Audits Will Look Like

The HHS Office for Civil Rights (OCR) recently presented information about the new look of its Phase 2 audit program. The new audits will look little like the old ones, with OCR conducting the audits itself and focusing on...more

Future OCR Audits Have Little in Common With Previous Round—Here’s How to Prepare

The HHS Office for Civil Rights (OCR) recently presented information about the new look of its Phase 2 audit program. The new audits will look little like the old ones, with OCR conducting the audits itself and focusing on...more

No More Excuses: HHS Issues New HIPAA Tool for Small Businesses

Three U.S. Department of Health and Human Services (“HHS”) agencies, the Office for the National Coordinator for Health IT (“ONC”), in conjunction with the Office for Civil Rights (“OCR”) and the Office of the General Counsel...more

OCR to Resume HIPAA Audits. Get Ready Now!

In a Feb. 24 notice in the Federal Register, the HHS's Office for Civil Rights (OCR) announced its intention to resume its HIPAA Audit Program. By and large, the audit program has been inactive since December 2012, when OCR...more

HIPAA Audits Set to Begin in 2014: Another Enforcement Mechanism for HIPAA Compliance

The Department of Health and Human Services (HHS) is expected to launch its long-awaited HIPAA audit program sometime in 2014. The audit program will be run by HHS’ Office of Civil Rights (OCR), which is likely eager to get...more

Third Circuit Holds Judicial Review of Extrapolated Overpayment Determinations is Precluded

On February 12, 2014, the U.S. Court of Appeals for the Third Circuit held that Federal courts do not have jurisdiction to review HHS’s determination of a “sustained or high level of payment error,” one of two possible...more

Be Prepared – HIPAA Audits are Coming in 2014

Later this year, the Department of Health and Human Services (“DHHS”) is expected to launch its permanent HIPAA Audit Program. The HIPAA Audit Program is authorized under Section 13411 of the HITECH Act, and is designed to...more

GAO Calls For Consistency Among Medicare Contractors Postpayment Claims Review

The U.S. Government Accountability Office (GAO) recently published the results of a study examining the effectiveness of CMS’s contractors that conduct postpayment claims reviews to identify improper payments (i.e., Medicare...more

Healthcare Regulation Update: GAO Makes Recommendations to HHS and CMS Regarding Medicare Audit Consistency

Following a detailed study of the manner by which the Centers for Medicare and Medicaid Services (“CMS”) engages in postpayment claims reviews to identify improper payments, the U.S. Government Accountability Office (“GAO”)...more

Federal Government Aggressively Pursuing Health Care Fraud

Proactive self-audits help providers identify potential problems - The Federal Government is using every tool available to fight health care fraud and recover overpayments from health care providers. According to the...more

Introducing the "Compliance Corner"

Several governmental agencies, including the Internal Revenue Service (IRS), Department of Labor (DOL), Securities and Exchange Commission (SEC) and Department of Health and Human Services (HHS), have stepped up their audit...more

Highlights of the Joint NIST and OCR Safeguarding Health Information Conference

Earlier this week we attended the National Institute of Standards and Technology (NIST) and HHS Office for Civil Rights (OCR) 6th Annual Safeguarding Health Information Conference in Washington, D.C. (the NIST-OCR...more

Protecting Your Hospital From Over-Utilization Prosecutions

The government has been increasing its focus on healthcare fraud involving “quality” of care. This is an extremely difficult issue, especially for prosecutors. It is very difficult to define “quality” standards and then...more

OIG Concludes in Nationwide Review of Drug That Herceptin Has Often Been Overbilled

The HHS OIG has conducted a nationwide audit of the use and reimbursement of Herceptin (also known as trastuzumab), a Medicare-covered drug used to treat metastatic breast cancer, and has concluded in three audits released in...more

Utilizing the HIPAA audit protocols as a compliance tool By Kimberly J. Gold

Originally published in Compliance Today on December 1, 2012. ..Covered entities are now subject to privacy and security audits by OCR. ..OCR published audit protocols regarding its standards for such...more

HHS Publishes Roadmap for HIPAA Audits .

One of the less well-known provisions of the Health Information Technology for Economic and Clinical Health (or "HITECH") Act[1] is the requirement that the U.S. Department of Health and Human Services ("HHS") periodically...more

Federal Government Releases Protocol for HIPAA Privacy, Security and Breach Notification Audits

On June 26, 2012, the Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) released on its website the protocol that it has developed to serve as a guideline for recently-implemented HIPAA...more

OCR Releases HIPAA Audit Protocol

Protocol provides clues regarding areas of focus for ongoing HIPAA audits assessing compliance with the Privacy, Security, and Breach Notification Rules. The Office for Civil Rights (OCR) at the Department of Health...more

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