Audits Dept. of Health and Human Services

News & Analysis as of

Recent OIG Audits of Home Health and Hospice Surveys May Signal Increased Scrutiny on Worker Qualifications

Recent audits by the Department of Health and Human Services Office of Inspector General (“OIG”) conclude that state survey agencies in a number of states and a leading national accrediting agency serving the home health and...more

Real Guidance (Finally) On the Compliance Oversight Role of Boards

New guidance for boards of directors on what it means to have “reasonable oversight” for the implementation and effectiveness of corporate compliance programs could signal the beginning of a global trend towards more—and more...more

Upcoming HIPAA Audits May Target Financial Institutions—Here’s How to Prepare

Much like a tornado watch, the conditions appear to be right for a coming storm: the upcoming Phase 2 HIPAA audits. The Department of Health and Human Services Office for Civil Rights (OCR) has begun verifying contact...more

Senate Finance Committee Advances Medicare Audit and Appeals Bill

On June 3, 2015, the Senate Finance Committee approved by voice vote the Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015. Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) were...more

OIG Updates 2015 Work Plan: New medicare initiatives for hospitals, DMEPOS suppliers, clinical labs, GPOs

The OIG issued on May 28, 2015 an update to its 2015 Work Plan which includes several new Medicare initiatives for the OIG’s audit and inspection during the current fiscal year and forecasts broader areas of focus for future...more

Roadmap to Prison: Lessons Learned from the Criminal Prosecution of Alpha Ambulance’s Leaders

No one running an ambulance company ever planned to go to prison for doing his or her job. But that is a real possibility if the government knocks on the door, and the owner or manager is dishonest in his or her response to...more

HIPAA and “Meaningful Use” Audits: Issues to Consider and How to Prepare

As more and more providers adopt electronic health records (“EHRs”) systems (and with new regulations concerning their required use for purposes of Medicare billing for chronic care management, their popularity can only...more

Medicare Hospital Compliance Reviews are Legal and Sound, According to OIG

The Office of Inspector General for the Department of Health and Human Services (OIG) recently defended its practices pertaining to hospital compliance reviews in a published response to a letter from the American Hospital...more

OIG Defends Its Hospital Compliance Reviews in Response to AHA Criticism

The Office of the Inspector General for the Department of Health and Human Services(“OIG”) responded to concerns expressed by the American Hospital Association (“AHA”) regarding the OIG’s hospital compliance reviews,...more

Alert: Five Ways to Reduce Your HIPAA Liability

As of early December 2014, 1,170 security breaches under the Health Insurance Portability and Accountability Act (HIPAA) involving 31 million records had been reported to the U.S. Department of Health and Human Services (HHS)...more

Blog: Next Round of HIPAA Audits to Begin “Expeditiously”

During a media roundtable held this week, the Director of the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) Jocelyn Samuels provided additional information regarding the long awaited next round...more

HIPAA Compliance: Are You Prepared for the 2015 HITECH Act Audits?

In 2015, the United States Department of Health & Human Services (HHS) Office of Civil Rights (OCR) will begin enforcing the requirements of the Health Insurance Portability and Accountability Act (HIPAA) and the Health...more

HHS to Audit Hospital Reporting of GPO Payments: GAO Report Suggests Further Scrutiny of GPO Shareback with Hospitals

On November 24, 2014, the Government Accountability Office (“GAO”) published a report examining the contracting practices and funding structures of health care group purchasing organizations (“GPOs”) and their potential...more

Preparing for HIPAA Compliance Audits

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR), the office responsible for administering and enforcing the Health Insurance Portability and Accountability Act of 1996 (HIPAA), will...more

Blog: HHS OIG Hands Out 2015 Work Plan For Halloween

On Friday October 31, 2014, the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) released its annual “Work Plan” for fiscal year 2015. The Work Plan is a compilation of the OIG’s plans for...more

Blog: OCR Rep Discusses HIPAA Violations, Enforcement Actions, and Upcoming Audit Program

Last week, the National Institute of Standards and Technology (“NIST”), in conjunction with the U.S. Department of Health and Human Services’ Office for Civil Rights (“OCR”), hosted a conference entitled “Safeguarding Health...more

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

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

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