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HHS OCR/ONC Announce an Updated Version of Its HIPAA Security Risk Assessment Tool

The Office of the National Coordinator for Health Information Technology (ONC) and the HHS Office for Civil Rights (OCR) have recently launched a joint HIPAA Security Risk Assessment (SRA) Tool. The tool is designed to assist...more

Do I Believe You? Scienter Standard in a FCA Case

Two False Claims Act (“FCA”) cases have recently been decided by the United State Supreme Court, further clarifying one aspect of the FCA. In the recent decisions in U.S. ex rel Proctor v. Safeway, Inc. and U.S. ex rel....more

The USDOJ Continues to Increase Its Fraud Enforcement Actions Related To COVID-19 Relief Benefits

Fraud enforcement actions by the United States Department of Justice (USDOJ) continue to rise against companies and individuals related to their applications for and receipt of COVID-19 benefits. It appears that no type of...more

The DOJ Continues to Scrutinize Telemedicine

Telemedicine saw a dramatic increase during the COVID-19 pandemic. A recent study from the U.S. Department of Health and Human Services (HHS), released in December 2021, showed an increase in Medicare telemedicine visits...more

Hot Topics in Health Care – July 2022

AMA Provides a No Surprises Tool-Kit - As most health care providers know by now, the No Surprises Act (NSA) prohibits out-of-network health care providers from balance billing commercially insured patients, in certain...more

Eleventh Circuit Affirms Convictions Against Florida Physician, Pharmacist for Violating Anti-Kickback Statute

Prosecutions related to the submission of claims to Tricare for compounded pain creams continue. The Eleventh Circuit Court of Appeals affirmed convictions against a Florida pharmacist, physician, and Navy veteran for their...more

Health Care E-Note - January 2022

HELPFUL HINTS - The Federal No Surprises Act The Federal No Surprises Act (the “Act”) became fully effective on January 1, 2022. The Act protects enrollees in group and individual market plans (including ERISA plans) and...more

CMS Announces Additional Measures To Provide Home Health Agencies Greater Flexibility to Fight COVID-19

On March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced additional measures to provide home health agencies (“HHA”) greater flexibility when treating patients during the National Emergency....more

Alabama Board of Medical Examiners Passes Emergency Regulations Granting Temporary Licensure For Physicians, Physician Assistants...

Effective March 23, 2020, the Alabama Board of Medical Examiners (“ABME”), adopted emergency rules to provide for the issuance of emergency certificates of qualifications for physicians, physician assistants and...more

New Telehealth Rules to Address COVID-19

In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) has significantly expanded access to telehealth services for Medicare beneficiaries....more

Clinical Labs Beware: Review Your Marketing Arrangements

On October 24, 2018, Congress enacted the Eliminating Kickbacks in Recovery Act of 2018 (EKRA). EKRA is part of the “Support for Patients and Communities Act,” comprehensive legislation designed to address the opioid crisis. ...more

A New Anti-Kickback Law Targets Clinical Lab Marketing Arrangements

Some very important and potentially game-changing legislation was recently passed. On Oct. 24, 2018, Congress enacted the Eliminating Kickbacks in Recovery Act of 2018 (or EKRA) – a statute that potentially eliminates legal...more

Anthem Will Pay Record $16 Million To Settle Health Care Data Breach

Anthem, Inc., the country’s second largest insurer has agreed to pay $16 million to the U.S. Department of Health and Human Services, Office for Civil Rights (“OCR”) and take corrective action to settle potential violations...more

The OIG Reminds Healthcare Providers of Fraud Risk Factors When Deciding Whether to Exclude a Healthcare Provider or Require a CIA

With the continued proliferation of qui tam False Claims cases showing no signs of slowing down, not only must providers consider the amount of any monetary settlements, they must also consider whether the Office of Inspector...more

Alabama Legislature Considers State Law on Cybersecurity

On March 28, 2018, Alabama adopted a data privacy law, the Alabama Data Breach Notification Act of 2018 (SB318). While Alabama is one of the last states to adopt such an act, the Act is notable in its requirements, and...more

The Largest EMTALA Settlement Underscores the Difficulty of Treating Behavioral Health Patients in the Emergency Room

On June 2, 2017, Anderson, S.C.-based AnMed Health and the Department of Health and Human Services Office of Inspector General entered into the largest settlement under the Emergency Medical Treatment and Labor Act...more

Fraud and Abuse Investigations Should be Taken Very Seriously

According to the United States Government, fraud and abuse recovery has an excellent return for each investment dollar spent. According to the Health Care Fraud and Abuse Control (HCFAC) Program Report,released by the...more

Physicians Must Be Cautious When Responding To A Subpoena or Request for Medical Records

Doctors must educate themselves and particularly their staff on the legal obligations to protect the confidentiality of medical records and how to properly respond to subpoenas and requests for patients’ health information....more

The Materiality Standard In False Claims Actions

The Supreme Court decided Universal Health Services v. U.S. ex rel. Escobar on June 16, 2016 in which it ruled the implied false certification theory, previously recognized in several circuits, can form the basis for False...more

Burr Alert: Phase 2 HIPAA Audits

In an effort to review and examine compliance with the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations ("HIPAA"), the Department of Health and Human Services Office for Civil...more

CMS Finalizes the 60 Day Overpayment Rule

The Department of Health and Human Services’ (HHS) Center for Medicare and Medicaid Services (CMS) published its final rule on Friday, February 12, 2016. The final rule clarifies two key sections of the often described 60-Day...more

The Federal False Claims Act - Violations of Conditions of Payment or Conditions of Participation?

With the increase of Qui Tam lawsuits alleging violations of the federal False Claims Act ("FCA"), it is important to understand that FCA liability maybe predicated on whether the alleged wrongful act violated a condition of...more

CMS Offers To Settle All Acute Care Inpatient Claim RAC Appeals

CMS is offering to pay hospitals 68 percent of the allowable amount for all claims that are currently on appeal. Specifically, CMS is offering to settle "inpatient status" claims at 68 percent of the "net paid amount" within...more

HIPAA For Lawyers And Law Firms: What you need to know to prevent your law firm from paying MILLION$

For years now lawyers and law firms providing professional services to health care providers or health insurance plans should have had in place essential safeguards to meet the responsibilities and requirements as business...more

Drug Quality And Security Act

On Wednesday, Nov. 27, 2013, President Obama signed the Drug Quality and Security Act (the "Act"). The Act is an attempt by Congress to bring some compounding pharmacies that use certain bulk products under more federal...more

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