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OIG Advisory Bulletin Provides Clarification Regarding Exclusion from Federal Health Care Programs

Tuesday, May 21, 2013

This is for informational purposes only. It is not intended to be legal advice and does not create or imply an attorney-client relationship.

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$4.8M paid in largest HIPAA settlement to date

CMS issues proposed payment rules for inpatient hospital and long-term care hospital prospective payment system for 2015 fiscal year

Antitrust lessons from recent FTC successes in challenging hospital acquisitions in Ohio and Idaho

Ohio enacts new law revising the peer review statute

New Ohio law for reporting newborns diagnosed as opioid dependent

ACA collection efforts: Requirements for tax-exempt hospitals

CMS issues new and updated EHR FAQs

AHIMA issues position statement on copy and paste in EHRs

Important changes to CTP Formulary: Amendment to standard care arrangements required by April 1, 2014

Florida hospital system agrees to record-setting False Claims Act settlement

FTC reaffirms strong concerns regarding hospital consolidations

CMS updates and clarifies "two-midnight" rule: More Guidance on Reviewing Hospital Claims for Patient Status

Eligible hospitals act now!

CMS issues guidance on the probe and educate audits performed under the "two-midnight" rule

HHS issues guidance on HIPAA and sharing information related to mental health

OIG releases its 2014 work plan

Meaningful <i>and true</i> – Former hospital executive faces criminal indictment for false meaningful use attestation

Ohio law changed to permit advanced practice nurses and physician assistants to admit patients to hospitals under certain conditions

Recent False Claims settlement should serve as important reminder to all hospitals

Annual breach reporting deadline March 1

CMS extends EHR incentive program attestation deadline

CMS delays review of “two-midnight” rule until after September 30, 2014

With the support of the American Hospital Association, hospitals initiate a challenge to the “two-midnight” rule

Federal Court holds that a physician is considered an “employee” for purposes of the EMTALA whistleblower protection

Ohio State Medical Board issues new rules on terminating the physician-patient relationship and notifying patients when a physician leaves a practice

Assignment of requests for administrative law judge hearings of denied Medicare claims suspended for at least two years

2013 year in review and 2014 forecast

Ohio law revised to allow greater access to medical information under a durable power of attorney for health care

OIG and CMS extend EHR donation exceptions even longer than proposed and add other changes

New Law Requires Surgeons Performing Mastectomies in a Hospital to Follow Specific Guidance and Referral Standards

Ohio Supreme Court Upholds the Controlling Board's Medicaid Expansion

The Impact of Medicare’s "Two-Midnight" Rule

Meaningful Use Deadline Extended One Year

OIG Finds OCR Lacking in Oversight and Enforcement of HIPAA Security Rule

CMS Announces Increased Provider Enrollment Fee for 2014

Department of Justice Announces Health Care False Claims Act Settlements

Health Management Associates Repays CMS $31 Million

CMS Issues Additional Guidance on "Two-Midnight" Rule

Lawsuit Challenging Medicaid Expansion Filed in Ohio Supreme Court

Controlling Board authorizes expanded Ohio Medicaid program and challenge filed in Ohio Supreme Court

The Tuomey Saga – The Latest Chapter

CMS Delays Review of “Two-Midnight” Rule

No Rest for the Weary: The Feds Have Been Busy Fighting Health Care Fraud!

Medicaid Expansion Group Reaches Next Step in Initiated Statute Process

A New Breed of Whistleblower? Consulting Company Turns in its Own Health Care Client for Alleged False Claims

CMS Implements New Conditions for Payments Related to Inpatient Hospital Admissions

Center for Improvement in Healthcare Quality attains deeming authority

New OIG Opinion Leaves Door Open to New Preferred Hospital Networks Without Violating Kickback Statutes

The Journey of Medicaid Expansion from the Affordable Care Act to Ohio

Tuomey Fights Back Against False Claims Verdict

Summer is Here and the HEAT is On! The Government’s Health Care Fraud Prevention and Enforcement Action Team Has Been Busy!

89 People Arrested Nationwide in Health Care Fraud Sting

The Tuomey Saga Continues – Jury Rules that Tuomey Violated the Stark Law and False Claims Act

Health Care Fraud Enforcement Remains Hot as HEAT Continues Aggressive Enforcement of Health Care Laws in 2013

Doctor’s Sympathetic Statement to Patient Cannot Be Used as Evidence of Liability

OIG Updates Self-Disclosure Protocol and Confirms OIG’s Position on Penalties

Community Health Needs Assessment Requirements Spelled Out by IRS, Treasury Department

Healthcare Integrity and Protection Data Bank Merging with the National Practitioner Data Bank

HHS and CMS Propose to Amend Regulations Permitting Donation of EHR Items and Services

FTC files antitrust challenge to hospital system's acquisition of primary care physician group practice

Ignoring Possible Billing Errors May be Enough to Support a "Reverse" False Claims Lawsuit

Health Care Providers Take Note: Your Contract With An HMO May Require Affirmative Action Compliance, Even If It Doesn’t Say So

CMS Conditions of Participation: Try, try again

Drum Beat of Health Care False Claims Act Settlements Continued in February

Government Announces Record-Breaking Returns from Health Care Fraud Enforcement

U.S. Supreme Court rules for FTC in hospital merger case

Ohio Governor Kasich Discusses Budget, Taxes, Education and Health Care Reform During the 2013 State of the State

Analysis of Final HIPAA Omnibus Rule: Notice of Privacy Practices

Analysis of Final HIPAA Omnibus Rule: Research, GINA, Hybrid Entities and Other Miscellaneous Provisions

Analysis of Final HIPAA Omnibus Rule: Enforcement Provisions

Proposed gainsharing program passes federal antitrust review

2013 Already an Active Year in Health Care False Claims Act Settlements

Analysis of the Final HIPAA Omnibus Rule: Individual Rights Regarding Restrictions and Access

Analysis of Final HIPAA Omnibus Rule: Business Associates and Business Associate Agreements

HHS Releases New Sample HIPAA Business Associate Agreement

Analysis of the Final HIPAA Omnibus Rule: Changes to Marketing, Sale of PHI and Fundraising Requirements

Once More Into the Breach: Major Changes to the HIPAA Breach Notification Requirements

What You Will and Won’t Find in the Final Omnibus HIPAA Rule

HHS Issues Final Omnibus HIPAA Rule

Federal Appeals Court Rules that a Medicare Recovery Audit Contractor’s Decision to Reopen a Claim for Review is Beyond Judicial Scrutiny

CMS Issues Final Rule Implementing Stage 2 of Meaningful Use

Medicare Recovery Audit Prepayment Review to Begin on August 27, 2012

Urgent Care Facility Chain Settles False Claims Act Lawsuit for $10 Million

Medicare Conditions of Participation: The good, the bad and the unsure

U.S. Supreme Court Upholds the Affordable Care Act

HIPAA Audit Protocols and OCR’s Plan Future HIPAA Audits – OCR Has a Plan, Despite What GAO Says

Supreme Court will hear case involving FTC’s challenge to the merger of only two hospitals in Albany, Georgia

Ohio’s New Law on Health Information Exchanges

Abbott Labs Settlement Highlights Importance of Taking Employee Complaints Seriously

Two Major Health Care Companies Pay $137.5 Million and $3.8 Million, Respectively, to Settle Violations Against the False Claims Act

Medicare Shared Savings Program Fraud and Abuse Waivers: Common Questions and Concerns

First Enforcement Action Under HITECH Breach Rules Results in $1.5M Settlement by Blue Cross Blue Shield of Tennessee

Requirements For Ordering Hospital Outpatient Services Clarified By CMS

'Tis the Season to [Not] Give Kickbacks

ACOs Take Two: Major Changes in Final Regulations

Multiple Government Agencies and Departments Make Coordinated Release of Final Medicare ACO Rules

Proposed Rule Modifies HIPAA's Accounting of Disclosures Requirements

Designated representative may sign APN standard care arrangement on behalf of collaborating physician

Two Companion Rules Completing the Stage 1 Criteria for the Electronic Health Record Incentive Program Released

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Ohio Supreme Court confirms Wuerth application to medical claims

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Supreme Court unanimously sides with American Hospital Association, 340B hospitals over outpatient drug reimbursement rates; 340B hospitals estimated to potentially recoup billions of dollars

Fifth Circuit, HHS Keep No Surprises Act dispute resolution provision in limbo; Delays expected

ESG and health care: Where does it fit?

CMS issues updated guidance for certified facilities on COVID-19 vaccine requirement as public health emergency continues

U.S. Supreme Court halts OSHA vaccine-or-test rule; Upholds CMS vaccine mandate

Legal updates on challenges to CMS vaccination mandate may cause more uncertainty

Hold the press! Federal court issues national injunction blocking CMS vaccine mandate for health care workers

Long-awaited federal vaccine mandates are here!

COVID-19 vaccines now available for most children and all teens

More federal courts dismiss legal challenges to hospital vaccine mandates

Reducing workers’ compensation and OSHA liability during COVID-19 and beyond

Health care facilities and nursing homes awaiting CMS requirements for staff COVID-19 vaccinations

FDA full approval of Pfizer vaccine should reduce risk of employer mandates

2022 Medicare OPPS/ASC Proposed Rule includes updated reimbursement rates, new policies, and reversals of recent policy changes

CMS proposes changes to Medicare rules governing certain Evaluation and Management visits

CMS proposes changes to Stark Law regulations and Open Payments Program

HHS updates interoperability standards to support sexual orientation and gender identity

Hospital price transparency rule penalties may increase

Ohio’s new hospital licensure law

Skilled nursing facility operator settles false claims case involving allegations that the company failed to report and return overpayments

Supreme Court makes certiorari determinations on two Medicare-related cases

First rules implementing surprise medical billing law issued

Ohio law governing EMS stroke protocols revised to include new guidelines and training

State of emergency in Ohio lifted

HHS releases new buprenorphine practice guidelines, relaxing waiver requirements

Ohio House Bill 6 affects changes to COVID-19 vaccine and test administration and certain temporary licenses

CMS begins enforcement of Hospital Price Transparency Rule

DOJ announces $22 million False Claims Act settlement with the University of Miami for provider-based and lab billing issues

CMS proposes changes to Promoting Interoperability program in IPPS Rule

New ACGME recognition for non-standard training of J-1 exchange visitor physicians

Ohio bill codifies changes to reporting requirements for hospitals related to defendant competency issues in criminal cases

Highlights from the Medicare Program 2022 Proposed Rule for Acute Care Hospitals Inpatient Prospective Payment System

Court upholds Ohio law criminalizing physician participation in abortions based on Down syndrome

Information blocking compliance – Are you ready for April 5?

Federal court sides with Eli Lilly challenge to HHS expansion of 340B discounts

Has COVID-19 forced the telehealth genie out of the bottle?

HIPAA Privacy Rule revisions in 2021

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Status of MFN drug pricing program remains uncertain

The Stark Law and Anti-Kickback Statute final rules: Top 10 takeaways

The uncertain future of the price transparency rule in 2021

Recent kickback cases yield almost $20 million in settlements for the United States

CMS issues mid-build audit determinations for provider-based locations

ACGME offers additional COVID-19 guidance for graduate medical education programs

CLER COVID-19 site visits to be conducted in 2021

Florida pediatrician pleads guilty to conspiring to falsify clinical trial data in research study for asthma medication for children

ODH issues guidance on redistributing COVID-19 vaccine doses

CMS to begin reprocessing hospital claims for 2019 clinic visits provided at excepted off-campus provider-based departments

Providers should account for extra doses of COVID-19 vaccines in their vaccination plans

Court of Appeals rules against hospitals in price transparency case

OCR continues aggressive HIPAA Right of Access enforcement activities

Biddle claims are here to stay, the Ohio Supreme Court holds

Ohio Department of Health to allow sex marker changes on birth certificates

Second stimulus bill contains “surprise” billing measure

HHS OCR announces results of most recent round of HIPAA audits

CMS announces proposed rule to improve electronic data exchange and streamline prior authorization

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