Compliance Healthcare

Compliance programs typically refer to formalized institutional procedures within corporations and organizations to detect, prevent and respond to indvidual and widespread instances of regulatory... more +
Compliance programs typically refer to formalized institutional procedures within corporations and organizations to detect, prevent and respond to indvidual and widespread instances of regulatory violations.  In response to many corporate scandals evidencing rampant unethical business practices, many nations, including the United States, began passing strict regulatory frameworks aimed at curbing these abuses. Notable pieces of legislation in this area include the U.S. Foreign Corrupt Practices Act (FCPA), Sarbanes-Oxley (SOX), and the U.K. Bribery Act, to name a few. The foregoing statutes and the severe penalties often associated with them form the basis of many modern institutional compliance programs. less -
News & Analysis as of

Employer Shared Responsibility Payments and Reporting Requirements Under the Affordable Care Act: Code Sections 6055 and 6056

Employer Shared Responsibility Penalties - There are two types of employer shared responsibility payments, also known as pay or play penalties, under the Affordable Care Act (ACA). The first penalty under Internal...more

North Carolina’s Medicaid RAC Program - Don't Let Your Guard Down

With Section 6411(a) of the Patient Protection and Affordable Care Act (ACA) and the Final Rules found at 42 CFR Part 455, the Recovery Audit Contractor (RAC) program has been expanded to the North Carolina Medicaid program,...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 17: Cherry Bomb in the Gold Fish Pond, or Third-Party Staffing...

With two seemingly simple and straightforward definitions in the final regulations implementing the Affordable Care Act’s pay-or-play rules—i.e., definitions of “employer” and “employee”— the Treasury Department and IRS have...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 19: Changes in Employment Status under the Look-Back...

An earlier post explained the two principle methods—the “monthly measurement method” and the “look-back measurement method”—available to applicable large employers to identify full-time employees for purposes of determining...more

What’s Scarier than a Compliance Officer Turned Whistleblower? A Whole Association of Them

In U.S. ex rel. Corporate Compliance Assocs. v. N.Y. Society for the Relief of the Ruptured & Crippled the court ruled that the whistleblower failed to meet the False Claims Act’s requirement that allegations be described...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 20: 9.5% ? 9.56% (And Why It Matters to Applicable Large...

While employers sometimes view the Affordable Care Act’s employer shared responsibility (or “pay-or-play”) rules in isolation, they don’t operate that way. Instead, they exist side-by-side with other provisions of the Act. In...more

Don't Delay: Deadline for ICD-10 Compliance for October 1, 2015 Still Underway

In a final rule released on July 31, the U.S. Department of Health and Human Services (HHS) confirmed October 1, 2015 as the compliance date for health care providers, health plans, and health care clearinghouses to...more

ICD-10 Compliance Deadline Is Now October 1, 2015

Health care providers, health plans, and health care clearinghouses (“Health Care Entities”) are required to comply with ICD-10 (which stands for the International Classification for Diseases, 10th Edition) on October 1,...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 21: Self-Funded Group Health Plans, the Affordable Care Act...

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ushered in broad national standards aimed at improving the efficiency and effectiveness of the U.S. health care system. Referred to generically as...more

Upcoming Health and Welfare Plan Requirements Checklist for Employers

As the mid-way point of 2014 approaches, employers should actively turn their attention to several upcoming compliance obligations for the health and welfare benefit plans they sponsor. Below is a checklist of upcoming...more

No delay of game – Affordable Care Act (ACA) compliance efforts should continue, despite court rulings

Perhaps you have put your compliance efforts on the back burner, hoping the ACA will just go away. We have heard many reasons for this procrastination, including the constitutional challenge to the individual mandate, the...more

Midyear Check on Health Plan Compliance

If you sponsor or administer a group health plan, you are almost certainly taking steps to prepare for legal requirements that will become effective on or before January 1, 2015. New rules under HIPAA, the Affordable Care Act...more

Putting the Ethics Back into Healthcare Compliance

We all know someone who is a pest, a professional colleague, a friend or even a family member. I use the term affectionately and especially when I write postings that are restatements of obvious points....more

Healthcare Ethics and Compliance Program Requirements

The Affordable Care Act included a mandate that medical service providers and suppliers enact compliance programs as a condition of participating in federal health care programs. (The ACA also set a deadline of March 23,...more

For ACA, Check Your Handbooks and Intranet

If you are like most employers, you have been diligently revising your benefits plans and working with your insurance providers to make sure your Summary Plan Descriptions comply with the Affordable Care Act. After those...more

Meaningful Compliance Equals Sound Financial Management

In traditional finance parlance the term "risk management" involves identifying events that can have adverse financial consequences and then taking action to prevent and/or minimize the damage caused by these events. Thus...more

Health Law Insights Newsletter - May 2014

In this Issue: - Federal Updates - State Updates - HIPAA Updates Excerpt from Federal Updates: The Centers for Medicare & Medicaid Services (CMS) issued a final rule to reduce unnecessary or...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

Perspectives - June 2014

In This Issue: - Staying in Compliance While Giving or Receiving Electronic Health Record Systems - When Donations Cross the Line - House Bill 296 Signed into Law to Increase Access to Epinephrine Autoinjectors...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 30: The IRS Tells Us that Employer Payment Plans (Really,...

The IRS recently issued two Q&As on the subject of employer payment plans, the purpose of which was to again underscore that arrangements purporting to allow an employer to reimburse employees on a pre-tax basis for premiums...more

OIG Proposes Updates to Exclusion and CMP Authority

The Department of Health and Human Services, Office of Inspector General (OIG) recently issued a pair of proposed regulations to update its exclusion and civil monetary penalty (CMP) authority. The proposed regulations...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 31: ERISA Section 510 and Limiting Employee Hours

In last week’s post, we examined the appropriateness of capping the annual hours of new “variable hour employees” as a way to limit exposure under the Affordable Care Act’s employer shared responsibility rules. (These rules...more

EARL e-News: USEPA To Review 100 Percent of Consent Decrees For Compliance - Updates on Environmental, Administrative and...

On April 10, 2014, USEPA released its 99-page Strategic Plan for Fiscal Year 2014 – 2018. As part of the Strategic Plan, USEPA set out its Mission is to protect human health and the environment. USEPA plans to accomplish its...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 32: Why Capping Annual Hours at 1560 Does Not Work

Whenever Congress draws a line in the sand—such as with exposure for assessable payments under the Affordable Care Act’s employer shared responsibly rules—entities subject to regulation (here, applicable large employers) will...more

HHS OIG Releases Proposed Rules Regarding Increased Authority to Combat Fraud and Abuse under the ACA

The Office of Inspector General (OIG) of the Department of Health and Human Services proposed two new rules last week in order to expand its enforcement authority, implementing changes adopted as part of the Patient...more

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