Compliance Dept. of Health and Human Services

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

HIPAA Security Requirements Aren't Cloudy, Especially to Whistleblowers

Earlier this month, the U.S. Department of Health and Human Services Office for Civil Rights (HHS OCR) announced that it had entered into a settlement agreement with St. Elizabeth's Medical Center (SEMC) in Brighton,...more

Cloud Sharing Apps Scrutinized for ePHI

In a relatively short time period, the direct costs of document storage have dropped precipitously, and cloud-based document storage has become ubiquitous. Clearly, this is a wave of the future. But a recent settlement...more

Blog: Court Holds Corporate Integrity Agreement May Be Basis for Reverse False Claim Liability

This week, a federal district court denied Cephalon Inc.’s (Cephalon) motion to dismiss a third amended complaint filed under the False Claims Act (FCA) by three qui tam relators in United States ex rel. Boise v. Cephalon,...more

CMS Issues Proposed Rule Reform for Long Term Care Facilities - Part 1 of 4

On July 13, 2015, CMS issued a proposed rule to reform the requirements for long term care facilities participating in Medicare and Medicaid. The 400-page proposed rule recommends the biggest overhaul to nursing home...more

Don't Fumble Your HIPAA Obligations: Ensure Your HIPAA Playbook Implements Appropriate Protections for Patients

The injuries suffered by a professional football player brought the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations ("HIPAA") onto center stage of the media during the days...more

CMS Issues Proposed Rule Revising Long-Term Care Facility Requirements

On July 16, 2015, the Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to revise the requirements long-term care facilities must meet to participate in the...more

HIPAA Settlement Regarding Use of Internet Applications

On July 10, 2015, the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) announced a settlement agreement with St. Elizabeth's Medical Center (SEMC) in Brighton, Massachusetts, regarding potential...more

Recent HHS Settlement Highlights Risks of Electronically-Sharing Protected Health Information

On July 10, 2015, the United States Department of Health and Human Services Office for Civil Rights (OCR) announced its second settlement of the year for violations of the Health Insurance Portability and Accountability Act...more

Use of File-Sharing Service Leads To $218,400 Fine For HIPAA Violations

Internet-based file-sharing services such as Dropbox and Google Drive can be easy and convenient to use, whether via the touch of an app on a mobile device or by opening a browser on a PC. Healthcare professionals are often...more

Massachusetts Hospital Agrees to Six-Figure Payment Related to HIPAA Compliance Allegations

St. Elizabeth’s Medical Center (SEMC), a tertiary care hospital based in Brighton, Mass., agreed to pay $218,400 to address deficiencies in its HIPAA compliance activities. The SEMC settlement continues a pattern of...more

Agencies Issue Final Regulations on the Summary of Benefits and Coverage (SBC) Requirements

As promised in the FAQ issued on March 30, 2015, the U.S. Departments of the Treasury, Labor and Health and Human Services (the Departments) have issued final regulations regarding the summary of benefits and coverage (SBC)...more

OCR Enforcement Trends

On April 27, 2015, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced a resolution agreement with Cornell Prescription Pharmacy (CPP) pursuant to which CPP paid a $125,000...more

House and Senate Appropriations Committees Approve Funding Bills with Riders Targeting DOL, NLRB Initiatives

Both the House and Senate Appropriations Committees advanced bills this week to fund various federal agencies for FY 2016. Each chamber approved versions of spending measures that include riders prohibiting funding for a...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

OIG Releases New Compliance Oversight Guidance for Health Care Governing Boards

On April 20, 2015, the U.S. Department of Health and Human Services Office of Inspector General (OIG), in conjunction with the American Health Lawyers Association (AHLA), the Association of Healthcare Internal Auditors (AHIA)...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

Blog: HIPAA FAQ Series: Are Covered Entities and Business Associates Required to Encrypt PHI?

The Health Insurance Portability and Accountability Act (HIPAA) mandates that both Covered Entities and Business Associates protect the security of Protected Health Information (PHI) in a variety of ways. Specifically,...more

The Medicaid Fraud Control Units: Fiscal Year 2014 Report

The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2014 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCUs)...more

"HHS OIG Issues New Compliance Oversight Guidance for Boards of Directors"

On April 20, 2015, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) published its “Practical Guidance for Health Care Governing Boards on Compliance Oversight” (the Guidance).1...more

Employee Benefits Developments - April 2015

Health Insurance Company’s HIPAA Breach Affects Millions. At the end of January, a national BlueCross BlueShield affiliate, Anthem, Inc., discovered that its information technology systems were hacked. The information...more

New Compliance Guidance for Health Care Boards

New compliance guidance for Boards of health care organizations was issued April 20, 2015. The document – “Practical Guidance for Health Care Governing Boards on Compliance Oversight” – was a joint effort of the Office of...more

Compliance Corner: Long-Term Care and the OIG Work Plan: As HHS Sharpens its Focus, Providers Should Set Their Sights on...

In the fall of 2014, the Department of Health and Human Services Office of Inspector General released its 2015 Work Plan, which highlighted HHS’s compliance focus areas in the upcoming year. As in past years, areas of...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

Why Providers Should Think About the Impact of ICD-10 on Managed Care Reimbursement Now

ICD-10 implementation has been delayed by Medicare until October 2015. Many believe it may be delayed again and are putting off thinking about its impact until it is clear that the updated code set will be implemented by...more

Health & Human Services, Office of Inspector General, Proposes New Fraud and Abuse Rules

The U.S. Department of Health & Human Services, Office of Inspector General (OIG) published 79 Fed. Reg. 59717 on October 3, 2014. This proposed rule has the potential to have an impact on a broad array of financial...more

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