Health Care Providers Audits

News & Analysis as of

OIG’s 2016 Work Plan: Mixed Results for 2015 and New Data Mining and Policy Efforts in 2016

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) annual release of a new Work Plan both summarizes the results achieved last year and highlights new areas for examination in the next....more

Developments in Long-Term Care Q2 2015

The following summary highlights key federal court developments and administrative decisions involving skilled nursing facility survey and related issues during the second quarter of 2015....more

Meaningful Use Audits: Proactive Tips for Success

For health care professionals who began accepting Meaningful Use incentive money at the outset of availability under the Medicare option in 2011, the year 2015 is an important year. If the provider has met all core...more

OIG Reports Insufficient Oversight Of HIPAA Compliance

The HHS Office for Civil Rights (OCR) must improve its oversight and enforcement of patient information privacy and security rules by “covered entities” and their business associates under the Health Information Portability...more

Blog: HHS To Launch New HIPAA Audits in Early 2016 in Response to OIG Reports

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) issued two reports yesterday calling for the HHS Office of Civil Rights (OCR) to strengthen its Health Insurance Portability and...more

HRSA Publishes Proposed 340B Drug Pricing Program Omnibus Guidance - Comments Due to HRSA on or before Tuesday, October 27, 2015

On Friday, August 28, 2015, the Health Resources and Services Administration (“HRSA” or “the Agency”) published in the Federal Register Notice of its proposed “omnibus” or “mega” guidance (“Proposed Guidance”) regarding...more

A summary and analysis of HRSA's proposed 340B program guidance

On August 28, 2015, the US Department of Health & Human Services (HHS) Health Resources and Services Administration (HRSA) published its long-awaited, if still only proposed, 340B program guidance (Proposed Guidance). 80 Fed....more

Connecticut Enacts Health Care Legislation in June Special Session

On June 29 and 30, 2015, the Connecticut General Assembly conducted a special legislative session following the close of the 2015 regular session. Among other things, the General Assembly passed a bill to implement the state...more

Connecticut General Assembly Enacts Reforms To Medicaid Audit Statute

For many years, Medicaid providers have vigorously protested the Connecticut Department of Social Services' (DSS's) audit process and methodology, which many believe to be unfair and unnecessarily punitive. As a result, in...more

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

Health Care E-Note - June 2015

In This Issue: - Why, Again, Do You Think That Worker is an Independent Contractor? - I-9 and E-Verify Compliance Practices for Temporary Labor and Contractors - Excerpt From Why, Again, Do You Think That...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

OCR Launches Phase 2 HIPAA Audit Program with Pre-Audit Screening Surveys

Health Insurance Portability and Accountability Act of 1996 (HIPAA) covered entities have reported that the U.S. Department of Health and Human Services Office for Civil Rights (OCR) recently sent pre-audit screening surveys...more

HIPAA “Phase 2” Audits: Are You Ready?

The Civil Rights Office of the Department of Health and Human Services announced a “Phase 2” audit program in the Fall of 2014. That audit program was delayed due to funding issues, but appears to be back on schedule for...more

Look Out for Meaningful Use Audits by the Office of Inspector General

The Medicare and Medicaid Electronic Health Care Record (“EHR”) Incentive Program (commonly referred to as “Meaningful Use”) provides incentive payments to eligible physicians and hospitals for adopting, implementing,...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

Birmingham Medical News: Are You Ready for the Upcoming HIPAA Compliance Audits?

Earlier this year, the U.S. Department of Health and Human Services Office of Civil Rights ("OCR") announced its plan for a number of audits regarding compliance with the Health Insurance Portability and Accountability Act of...more

Religious Institutions: August 2014

If the Internal Revenue Service (IRS) had a moratorium on enforcing §501(c)(3) electioneering restrictions against churches and religious organizations, the IRS states that it has been lifted incident to the settlement and...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

Health Care in 2014: A Brave New World

With the completion of the enrollment phase of the Affordable Care Act (ACA), health care in the United States has entered a new era that will be characterized by extensive changes and challenges for both providers and...more

Victory in House of Representatives for Improvements to WOSB Federal Contract Program

On May 7, 2014, the Office of Federal Contract Compliance Programs (OFCCP) issued Directive 2014-01, instituting a five-year moratorium on the OFCCP enforcement over TRICARE subcontractors. The moratorium applies to health...more

HIPAA Impaired Providers and the ER - What Happens When Your Employee Becomes Your Patient?

I was speaking this week at IAHIMA’s Annual Conference on the issues relating to HIPAA audits and recent updates from OCR and ONC. As part of my program we typically solicit questions prior to the presentation, most of which...more

Audit Log Discovery As A Feature Of The Electronic Medical Record

The increased use of electronic medical records ("EMR") is changing not only the way physicians practice medicine but also the way discovery is conducted in medical malpractice lawsuits. Plaintiffs' attorneys seek to...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

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