News & Analysis as of

Health Care Providers Audits Healthcare

Nelson Mullins Riley & Scarborough LLP

Medicaid Overpayment Audits: What Medical Providers Need to Know

The Audit Process - While Medicaid audits are meant to ensure integrity and efficiency of the Medicaid Program, they can often be incredibly cumbersome and challenging for medical providers to navigate. During an audit,...more

Ankura

OIG Testimony Puts a Spotlight on Clinical Documentation and Payer Risk

Ankura on

In recent testimony before the United States House Committee on Energy and Commerce Subcommittee on Oversight and Investigations, Christi A. Grimm, Inspector General of the Department of Health and Human Services (HHS)...more

Dentons

Ep. 13 - Before You Audit… The Importance of Pre-Audit Planning

Dentons on

Audits are an important part of a compliance program and help monitor compliance obligations, identify non-compliance, and quantify overpayments. But, planning the audit is often just as important as the audit itself.  One of...more

ArentFox Schiff

Fast Five: Important Law and Policy Updates for US Health Care Transactions

ArentFox Schiff on

With the end of the first quarter of 2024, we highlight five developments, changes, or challenges that health systems, hospitals, nursing homes, clinics, physician practices, health insurers, and other health care providers,...more

Bass, Berry & Sims PLC

Court Guts 340B Program “Patient” Definition, Opening Door to More 340B Use

Bass, Berry & Sims PLC on

On November 3, a federal district court issued a monumental decision endorsing an expansive view of who is a “patient” of a 340B program covered entity eligible to receive a 340B drug. In Genesis Healthcare, Inc. v. Becerra,...more

McDermott Will & Emery

HIPAA Compliance 101: Lessons from a Recent OCR Settlement

McDermott Will & Emery on

The US Department of Health and Human Services Office for Civil Rights (OCR) recently announced a settlement with a community hospital resolving an investigation under the Health Insurance Portability and Accountability Act...more

Ballard Spahr LLP

HHS OIG to Review CMS Citations

Ballard Spahr LLP on

Summary - The Department of Health and Human Services Office of Inspector General (HHS OIG) has announced its intention to comprehensively review nursing home citations issued by the Centers for Medicare and Medicaid...more

Groom Law Group, Chartered

CMS Medicare Advantage RADV Final Rule: No Fee-For-Service Adjuster, May Extrapolate Audit Findings Beginning with PY 2018

More than four years after it was proposed, on February 1, 2023 the Centers for Medicare & Medicaid Services (CMS) published the long-awaited risk adjustment data validation (RADV) Final Rule (Final Rule) that will affect...more

K&L Gates LLP

Veteran Affairs Auditing US$35 Billion in Payments to Community Care Providers

K&L Gates LLP on

The Department of Veteran Affairs (VA) has long outsourced care for veterans that the VA could not provide and for veterans’ emergency care (community care). Over the past decade, the VA has experienced significant...more

Burr & Forman

Meaningful Use Audits: Proactive Tips for Success

Burr & Forman on

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

King & Spalding

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

King & Spalding on

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

Robinson & Cole LLP

Connecticut Enacts Health Care Legislation in June Special Session

Robinson & Cole LLP on

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

Foley & Lardner LLP

Recent OIG Audits of Home Health and Hospice Surveys May Signal Increased Scrutiny on Worker Qualifications

Foley & Lardner LLP on

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

Snell & Wilmer

HIPAA “Phase 2” Audits: Are You Ready?

Snell & Wilmer on

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

Parker Poe Adams & Bernstein LLP

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

Troutman Pepper

Health Care in 2014: A Brave New World

Troutman Pepper on

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

PilieroMazza PLLC

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

PilieroMazza PLLC on

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

Dentons

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

Dentons on

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

Mintz - Health Care Viewpoints

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 audits. ...more

Epstein Becker & Green

HHS Publishes Roadmap for HIPAA Audits .

Epstein Becker & Green on

One of the less well-known provisions of the Health Information Technology for Economic and Clinical Health (or "HITECH") Act[1] is the requirement that the U.S. Department of Health and Human Services ("HHS") periodically...more

Morgan Lewis

OCR Releases HIPAA Audit Protocol

Morgan Lewis on

Protocol provides clues regarding areas of focus for ongoing HIPAA audits assessing compliance with the Privacy, Security, and Breach Notification Rules. The Office for Civil Rights (OCR) at the Department of Health...more

Poyner Spruill LLP

Shorts on Long Term Care - May 2012

Poyner Spruill LLP on

In this issue: - A Sign of the Times: Nonpayment of Resident Accounts, Transfer/Discharge and Related Issues - Responding to an Audit? Be Prepared! - Ken’s Quote of the Month An excerpt from...more

22 Results
 / 
View per page
Page: of 1

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide