Health Care Providers Dept. of Health and Human Services

News & Analysis as of

ACA Nondiscrimination Regulations Finalized

The U.S. Department of Health and Human Services (HHS) has issued final regulations under Section 1557 of the Affordable Care Act (ACA) which prohibit discrimination on the basis of race, color, national origin, sex, age, or...more

New ADA and GINA Wellness Regulation Changes Complicate Wellness Program Compliance Analysis and Risks

Wellness programs should all be reviewed considering the Americans with Disabilities Act (“ADA”) and the Genetic Information Nondiscrimination Act (“GINA”) regulatory changes because noncompliance with the new requirements do...more

U.S. Department of Health and Human Services Updates Criteria for Permissive Exclusion Under Section 1128(b)(7) of the Social...

The HHS-OIG issued new guidelines on April 18, 2016 regarding the Secretary's exercise of the Department's permissive exclusion authority pursuant to Section 1128(b)(7) of the Social Security Act. The HHS-OIG's new guidance...more

New ACA, et. al. FAQs Cover Items From “Top” to “Bottom”

On April 20, the “Big Three” agencies (DOL, Treasury/IRS, and HHS) released another set of FAQs (the 31st, for those of you counting at home). Consistent with earlier FAQs, the new FAQs cover a broad range of items under the...more

Department of Health and Human Services Cracks Down on Vendor Oversight in Recent Hospital Settlements

From the rise in ransomware attacks to inadvertent disclosure of information by subcontractors, the health services industry is reminded that a potential consequence of a data breach is the threat of a regulatory enforcement...more

Not a Check-the-Box Exercise: Failure to Have Signed BAA Results in Substantial Fine

A group practice that was the victim of a silver-harvesting scam has agreed to pay the U.S. Department of Health and Human Services (“HHS”) $750,000 to settle charges that it released protected health information (“PHI”) of...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On April 15, 2016, the Food and Drug Administration (FDA) issued a proposed rule entitled, “Applications for Approval and Combinations of Active Ingredients Under Consideration for...more

Ex-Husband's Revenge Leads to HHS Trophy

Patient care is not confined to a single office or exam room, or a single physician or other provider. Caring for patients these days now includes complex coordination among physicians, nurse, technicians, staff, management,...more

New Guidance on Exclusion

For the first time in nearly 20 years the Office of Inspector General (OIG) of the Department of Health & Human Services has issued new guidance on the exercise of its authority to exclude health care providers from...more

OIG Continues its Focus on GIP Abuse: What Hospice Providers Need to Know

On March 31, 2016, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a report on hospice billing for general inpatient care (GIP). According to the OIG, hospices billed Medicare for...more

OIG laments failure to comprehensively address EHR fraud

The U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) recently released a compendium (Compendium) of its top unimplemented recommendations. The Compendium comprises 25 unimplemented past OIG...more

HHS to Apply Medicare Rates for Physician, Other Health Services Purchased by IHS-Funded Programs

Sylvia Mathews Burwell, Secretary of the U.S. Department of Health and Human Services (HHS), on March 21, 2016, issued a final rule to apply Medicare payment methodologies to all physician and other health professional...more

I’ll Gladly Pay You 10 Years From Today for Care Already Provided

Most providers whose claims have been determined to be improper by the Recovery Audit Contractors (RACs) under the Medicare Recovery Audit Program have discovered that the appeals backlog “is incontrovertibly grotesque.”...more

DOJ Launches Task Force Initiative, Targets Long Term Care Providers

The U.S. Department of Justice (DOJ) is assembling 10 regional Elder Justice Task Forces that will target skilled care facilities that provide substandard care to residents. The DOJ’s task forces consist of members from U.S....more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On March 29, 2016, Centers for Medicare & Medicaid Services (CMS) issued a final rule entitled, “Medicaid and Children’s Health Insurance Programs: Mental Health Parity and...more

Improper Disclosure of Research Information Results in $3.9 Million Settlement

On March 17, 2016, the U.S. Department of Health and Human Services, Office for Civil Rights (“OCR”) announced that the Feinstein Institution for Medical Research (“Feinstein”) agreed to pay $3.9 million to resolve...more

Health Law Insights Newsletter - Issue 7 - March 2016

McCarter & English, LLP’s Health Care Group presents Issue 7 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - Providers’ Obligation to Report Medicare...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On March 15, 2016, the Centers for Disease Control and Prevention (CDC) issued voluntary guidelines entitled, “CDC Guidelines for Prescribing Opioids for Chronic Pain — United...more

OIG Approves Free Transportation and Lodging for Certain, Low-Income Pregnant Women - Advisory Opinion 16-02

On March 1, 2016, the Department of Health and Human Services, Office of Inspector General (OIG) issued Advisory Opinion 16-02 [PDF], approving an academic medical center's (AMC's) provision of free transportation and lodging...more

Alabama Approved for Statewide Medicaid Managed Care

Alabama Governor Robert Bentley announced on February 9, 2016, that the State has been granted a waiver pursuant to Section 1115 of the Social Security Act (1115 waiver), authorizing Alabama to change the delivery of Medicaid...more

HHS Seeks Nominees for New Health Care Cybersecurity Task Force; Nominations Due March 9

HHS is forming a new “Health Care Industry Cybersecurity Task Force” as part of the Administration’s effort to improve preparedness for cybersecurity threats affecting the health care industry. HHS is accepting nominations...more

Help with HIPAA!

The U.S. Department of Health & Human Services has published answers to some frequently asked questions about an individual’s right to access identifiable health information. Are the FAQs boring? Absolutely. But are they...more

Federal Court finds “Systemic Failure” in Processing of Administrative Appeals for Medicare Reimbursement Claims

A win for efficiency: The AHA suit may force shorter adjudication times for Medicare administrative appeals. In 2014, the American Hospital Association (AHA), along with three hospital systems, filed suit against the U.S....more

HHS releases HIPAA guidance on care coordination and case management

In its third release of HIPAA guidance over the past few weeks, the Department of Health and Human Services (HHS) released“The Real HIPAA: Care Coordination, Care Planning, and Case Management Examples” to assist covered...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On February 24, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a guidance entitled, “Special Enrollment Confirmation Process” that will enhance program integrity...more

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