Industries & Practices

Health Care Law

Back

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.

Download PDF

Related Insights

What to expect now that we’re expecting: What the end of the public health emergency means for healthcare providers Part 2: Guidance on telehealth

What to expect now that we’re expecting: What the end of the public health emergency means for healthcare providers

Are you regulated under HIPAA? Ensure your website or app’s user tracking is HIPAA compliant

Ohio Supreme Court confirms Wuerth application to medical claims

CMS restores 340B drug acquisition reimbursement

Ohio Department of Health proposes draft Health Care Service rules for comment

Malpractice does not equal murder

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

Information Blocking in 2021

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

What health care providers need to know as COVID-19 vaccines arrive in Ohio

Major changes to HIPAA Privacy Rule proposed

CMS releases Hospital 2021 OPPS final rule

Will you be ready when the COVID-19 vaccines arrive?

CMS and OIG finalize major changes to Stark and Anti-Kickback regulations: What health care entities need to know

CMS and OIG issue long-awaited final rules changing the Stark Law, Anti-Kickback Statute and Beneficiary Inducement Civil Monetary Penalty Law

New rules in Ohio affecting consult agreements with pharmacists

ONC extends Information Blocking compliance deadlines

Ohio Medicaid telehealth changes made permanent

OCR announces second-largest HIPAA breach settlement

OCR settles five additional cases in HIPAA Right of Access Initiative

Ohio Supreme Court rules that the savings statute cannot save a late second filing

OCR recommends IT asset inventory for HIPAA compliance

Governor signs qualified immunity bill for COVID-19 related lawsuits

COVID-19 Update: CMS announces resumption of survey activities

Medicare to begin requiring orders for repeat COVID-19 and related tests

CMS issues new COVID-19 guidance, including nursing home staff testing requirements

COVID-19 Update: OCR updates guidance on contacting former COVID-19 patients about blood and plasma donation to add health plans

CMS to require a positive COVID-19 viral test result for additional 20 percent Medicare payment

Deadline approaching to submit promoting interoperability hardship exception to avoid payment adjustment

Court of appeals rules that HHS has the authority to cut 340B hospitals’ Medicare payments for outpatient drugs by 28.5 percent

COVID-19 Update: CMS waivers continue as public health emergency extended, debate grows on which waivers should become permanent

HIPAA settlement highlights importance of mobile device encryption

Wide-ranging executive orders regarding pharmaceutical pricing and availability

Medicare program resuming fee-for-service audits and DMEPOS prior authorization program paused during COVID-19 pandemic

IRS moves CHNA due dates to December 31, 2020

SAMHSA announces changes to substance abuse treatment records in 42 CFR Part 2

D.C. Circuit upholds Medicare policy of paying hospital outpatient provider-based locations and physician offices the same, reversing lower court

Telehealth services expanded in Ohio by new executive order

CMS announces restart of Review Choice Demonstration for Ohio home health agencies

The FTC and the DOJ finalize new vertical merger guidelines

ACGME sponsoring institution emergency categorization

Anticipating COVID-19 enforcement action: Risks for providers

COVID-19 Update: OCR issues guidance on contacting former COVID-19 patients about blood and plasma donation

Medicare to require prior authorization for certain outpatient department services starting July 1, 2020

Increased reimbursement for hospital stays for Medicare beneficiaries with COVID-19 diagnosis likely to lead to audits and False Claims lawsuits

CMS issues first of two final rules changing the Medicare Advantage and Medicare Prescription Drug Program

Expanded CMS survey activities to begin, nursing home survey activities to increase

All surgeries and procedures may resume, according to Ohio governor

Surprise COVID-19 medical bills: What providers can and cannot do

Transition to a single graduate medical education (GME) accreditation system

COVID-19 Update: Ohio issues final plan for health care isolation centers

ACGME issues procedures for investigation and enforcement of non-compliance with its COVID-19 requirements

CMS issues nursing homes best practices toolkit to combat COVID-19

COVID-19 Update: Final rule adopted requiring long-term care facilities to report COVID-19 data

COVID-19 Update: CMS allows hospitals to provide swing bed services

COVID-19 Update: Providers beware – OCR reiterates that HIPAA restrictions on disclosures to the media apply during the pandemic

COVID-19 Update: The impact of COVID-19 on health care private equity due diligence

COVID-19 Update: New CMS changes that impact medical education

COVID-19 Update: Medicare to waive more testing, telehealth, hospital requirements

COVID-19 Update: ODH issues order allowing providers to resume some non-essential surgeries and procedures

COVID-19 Update: CMS issues explanatory guidance on Stark Law blanket waivers

COVID-19 recovery: Financial aid and resources for hospitals and health care providers

COVID-19 recovery: Legal considerations for hospitals and health systems planning for post-pandemic operations

Clinical research flexibilities during the COVID-19 public health emergency

COVID-19 Update: CMS and ONC delay interoperability rules

COVID-19 Update: ODH announces elective surgery order

COVID-19 Update: Beware of cooperation in the labor market

COVID-19 Update: Pandemic implications for GME programs

COVID-19 Update: CMS issues guidelines on providing non-emergent and non-COVID-19 health care

COVID-19 Update: Providers participating in COVID-19 clinical trials now eligible for MIPS credit

COVID-19 Update: CMS issues guidance on transferring long-term care residents

COVID-19 Update: CMS and Ohio Board of Pharmacy issue new and updated regulatory waivers

COVID-19 Update: New Ohio orders require nursing homes and residential care facilities to notify residents of COVID-19 cases and require first responders to be told of COVID-19 cases

COVID-19 Update: DOL, HHS and Treasury issue FAQs for group health plans and insurers on COVID-19 testing and provider visits

ONC interoperability rule: Notable exceptions to upcoming information blocking prohibition

COVID-19 Update: OCR announces HIPAA enforcement discretion for community-based testing sites

COVID-19 Update: OCR issues bulletin on civil rights laws during public health emergency

COVID-19 Update: OIG extends Kickback Statute protection to arrangements covered by blanket COVID-19 Stark law waivers

COVID-19 Update: Data sharing requests and orders for hospitals

COVID-19 Update: New guidance on HIPAA issues

COVID-19 Update: CMS issues new 1135 blanket waivers

COVID-19 Update: HHS issues 18 blanket waivers of enforcement of Stark law

COVID-19 Update: Health care provisions of the federal stimulus bill

COVID-19 Update: How Ohio's coronavirus emergency bill impacts health care providers

COVID-19 Update: Cost-report reimbursement impact of expanding hospital inpatient bed capacity

COVID-19 Update: HHS implements president’s executive order to prevent medical resource hoarding

CMS delays activation of systematic validation edits for OPPS providers with multiple service locations until further notice

COVID-19 Update: CMS announces relief for providers participating in quality reporting programs

COVID-19 Update: ODI issues bulletin on out-of-network coverage for coronavirus testing and treatment

COVID-19 Update: ODM issues emergency telemedicine rule

COVID-19 Update: OMHAS issues emergency telemedicine rule

COVID-19 Update: Extending Medical Staff appointment/privilege periods during the coronavirus outbreak

COVID-19 Update: FDA announces policies to increase availability of coronavirus testing

COVID-19 Update: Ohio Pharmacy Board issues guidance regarding practice of pharmacy

COVID-19 Update: President Trump expands Medicare telehealth benefits during coronavirus outbreak

COVID-19 Update: Telehealth – waiver of HIPAA requirements and expanded flexibility

COVID-19 Update: HHS issues EMTALA waiver for actions necessitated by COVID-19

COVID-19 Update: HHS issues limited 72-hour HIPAA waiver for hospitals

COVID-19 Update: OMHAS issues guidance for opioid treatment programs

COVID-19 Update: What the president’s declaration of national emergency means for health care facilities

COVID-19 Update: Preparedness for long-term care facilities

COVID-19 Update: Survey suspension FAQs

COVID-19 Update: CMS issues EMTALA guidance

COVID-19 Update: Ohio confirms first cases

HHS releases final rules on interoperability and information blocking

COVID-19 Update: Reimbursement issues – Who is picking up the tab for coronavirus testing?

CMS announces actions to address the spread of COVID-19

Medicare Administrative Contractors request hospitals to verify practice locations

Coronavirus: Patient privacy implications

PA appellate court holds that physician credentialing file is not protected by the state peer review privilege

Clinical trials and Medicare billing: Avoiding false claims liability

Court confirms that federal enactments regarding “never events” and “hospital acquired conditions” don’t alter elements that plaintiffs must prove in medical negligence claims

EHR vendor Practice Fusion agrees to $145 million settlement to resolve criminal and civil kickback violations

Best practices for resolving patient incapacity issues

Changes coming to the Stark Law and Anti-Kickback Statute regulations

Could new Individual Coverage HRAs replace your group health plan?

Proposed vertical merger guidelines have finally arrived

Roadmap to an effective compliance investigation

The new price transparency rule: Are you ready?

New hospice care program rules effective January 23, 2020

CMS announces reduced psychiatric hospital burden with new survey process

Ohio Department of Health issues draft amendments to Certificate of Need rules

Federal court denies American Hospital Association review of CMS 2020 site-neutral payment cuts for hospital off-campus provider-based locations

CMS proposes new Stark Law exception for limited remuneration to a physician

OIG proposes changes to existing Anti-Kickback Statute safe harbors

CMS announces continuation of second year of site-neutral payment cuts

CMS clarifies the process for correcting mistakes under the Stark Law

CMS and OIG propose three new value-based care exceptions to remove value-based payment barriers

CMS and OIG propose changes to existing rules for donations of electronic health records and new rules for donations of cybersecurity technology and services

Tentative settlement resolves antitrust claims against health system on the eve of trial

CMS proposes to change the way group practices can pay profit shares to physicians under Stark Law

CMS proposes to recalibrate the scope and application of the Stark regulations

CMS proposes changes to and clarifications of key Stark Law terms

CMS and OIG issue long-awaited rules proposing changes to the Stark Law, Anti-Kickback Statute and Beneficiary Inducement Civil Monetary Penalty Law

Recent Stark Act decision could have significant impact for employed physicians compensated based on personal productivity

CMS to survey hospitals about acquisition costs for 340B drugs

Post-acute providers beware: Providing free staff or services to hospitals could land you in hot water…or worse!

Federal court invalidates CMS site-neutral payment cuts for hospital off-campus provider-based locations

Hazardous waste pharmaceuticals rulemaking

OCR begins HIPAA right of access enforcement initiative

Recent OIG audit report on duplicate Medicare payments for drugs prescribed to hospice patients shows tension between OIG and CMS on whether CMS has gone far enough to prevent duplicate payments

Ohio Budget Bill changes Ambulatory Surgical Facility definition: Now captures facilities operating within a hospital

Attorney General Yost announces multistate data breach settlement with Premera

CMS proposes payment cuts for hospital clinic visits in off-campus provider-based departments

Anxiety and autism voted down: Not added as qualifying conditions for medical marijuana

Ohio budget bill provides significant changes to Certificate of Need laws

DeWine signs Executive Order allowing emergency rule changes as part of Ohio’s “Behavioral Health Redesign”

CMS issues hospice payment rate final rule for FY2020

CMS proposes changes to SNF/NF compliance program requirements

Could relief from the Medicare cuts in reimbursement for 340B drugs be coming soon for hospitals?

OIG says Part D contracts cost Medicare as much as $75 million in lost drug manufacturer rebates in one year

HHS publishes fact sheet on direct liability of business associates under HIPAA

DOJ updates guidance on evaluating the effectiveness of corporate compliance programs

CMS draft guidance on hospital co-location offers narrow sharing of hospital space

Ohio EPA initiates rulemaking process for hazardous waste pharmaceuticals

Behavioral Health Redesign provisional measures extended

Duke University to pay $112 million in research fraud settlement

ODH provides guidance on inpatient palliative care to non-hospice patients

Hospitals with off-campus provider-based departments: Check your PECOS enrollment file

CMS directive orders state agencies to increase weekend surveys of skilled nursing facilities

Clinical trial agreements: Hidden risks of poorly negotiated CTAs

CMS and ONC release proposed rules on interoperability and information blocking

Proposed California drug pricing program could shift 340B drug reimbursement away from hospitals

The Eliminating Kickbacks in Recovery Act of 2018: A new federal kickback law affecting the substance abuse treatment community

H.B. 7 effective March 20

A 60-Day Overpayment Refund Rule update

CMS and the Ohio Department of Health surveys: Active enforcement and increased transparency

Federal court overturns 340B Drug Discount Program reimbursement cuts – future still uncertain

HHS regulatory sprint to coordinated care: Will meaningful changes make it across the finish line?

Not conducting exit interviews on your departing employees? You should be!

ODH alignment recommendations for 2019 CHNA process

TCJA excise tax on excess executive compensation for nonprofits

U.S. hospitals will continue to grapple with GDPR compliance in 2019

Using social media to detect workers’ compensation fraud

Coming soon: Changes to Ohio law governing hospices’ provision of palliative care and new requirements for hospitals to identify patients needing palliative care

DOJ moves to dismiss 11 False Claims Act cases

Best practices for resolving incapacity issues, including navigating the probate court process for establishing guardianships

HHS releases voluntary cybersecurity guidance for health care organizations

New standard authorization forms must be accepted by health care providers in Ohio

Congress enacts all payor kickback law for recovery homes, clinical treatment facilities and clinical laboratories, despite concerns about overbreadth and uncertainty of law

Failure to terminate access of departing employee leads to HIPAA penalty

The Ohio medical marijuana patient registry is now open: Are you ready?

$24 million settlement resolves False Claims and Stark Law violations involving improper physician arrangements

HIPAA settlement highlights need for caution when speaking with media

OIG, DOJ put hospice providers under a microscope

FDA proposes waiver of informed consent requirements for minimal risk trials

2018 updates to the NPDB Guidebook

CMS finalizes site-neutral payment for clinic visits but declines to finalize clinical families payment limitation

CMS expands reimbursement cuts on 340B drugs

Ohio’s new cybersecurity safe harbor law takes effect

Medical professionals required to report suspected elder abuse, neglect or exploitation

OIG report finds Ohio Department of Medicaid made payments for deceased beneficiaries

340B litigation update: Both Ceiling Price Rule delay and 340B rate cuts face legal challenges

Lights, camera, HIPAA! HHS announces settlement related to “Boston Med”

Important clarification regarding compliance with certain Stark Law exceptions

Are you prepared for uncompensated care S-10 audits?

340B Drug Pricing Program spawns two antitrust lawsuits

FDA issues guidance on use of EHR data in clinical research

340B Drug Pricing Program

Federal appeals court rules against the American Hospital Association’s challenge to the $1.6 billion in Medicare 340B cuts

Personal liability trend continues: Health care CEO gets jail time for fraud scheme

DOJ conference remarks provide insight into government priorities related to health care

Judge upholds fourth largest HIPAA penalty of $4.3 million for Texas cancer center

New guidance from OCR regarding protected health information

Health system to pay $18 million to settle FCA lawsuit

Deadline approaching to submit meaningful use hardship exception to avoid payment adjustment

Recent hospice settlements highlight where things can go wrong

DEA imposters targeting physicians and pharmacies

Mental health provider faces False Claims Act lawsuit due to alleged unlicensed, untrained and unsupervised personnel

Hospice news update

CMS proposes to eliminate requirement for written inpatient admission orders

Pennsylvania case reminds Ohio hospitals of the importance of adhering to provisions of peer review statute

Recent 340B program developments

Collection and destruction of controlled substances recovered from hospital patients and visitors

Certification requirements for Ohio OTPs

The three-day rule for treating acute withdrawal symptoms

Ohio seeks to become the first state to receive a 1332 waiver of the individual mandate

Prescriber rules for opioids

EMTALA screening for behavioral health patients

Extended mental health care in the ED: What’s a facility to do?

Liability risks at every port along the opiate stream

Rules on confidentiality of substance use disorder patient records recently changed

Staffing and billing issues to avoid under Ohio scope of practice rules for mental health professionals

Bipartisan Budget Act of 2018 repeals therapy caps: What does it mean for hospital outpatient therapy departments?

Strange, and ultimately dangerous, credentialing scenarios highlight the need for MSPs’ roles to protect the public

Civil and criminal penalties increased for fraud and abuse

Important updates from the IRS for exempt organizations

CMS releases new and updated tips on billing for various services

CMS now allows medical student documentation for E/M billing

CMS plans complete overhaul of EHR incentive programs, announces new patient access initiatives

Doctor pleads guilty to providing protected health information to drug maker

Ohio Board of Pharmacy releases proposed rules on pain management and office-based opioid treatment clinics

EHR Incentive Program attestation deadline for hospitals extended to March 16, 2018

Keeping up with NIH rules impacting research involving human subjects

Reminder: Notice of 2017 small HIPAA breaches due to HHS soon

CMS releases updated resource documents for Hospice Quality Reporting Program

$350 million FCA verdict against nursing facility operator vacated

Clinical research compliance alert: Common Rule updated, effective date delayed

Reminder: Hospitals must use QualityNet for attestation in 2018

Antitrust enforcement priorities for 2018

CMS imposes massive cuts on 340B program; Hospital associations’ legal challenge dismissed

CMS Quality Payment Program: Are you ready for round two?

HIPAA access versus authorization

Hospice compliance: OIG Work Plan, quality reporting

Incident reports and peer review

Low Volume Appeals settlement option announced

Off-campus provider-based hospital outpatient departments: Challenges and options in 2018

Opioid prescribing and potential liability will impact providers in Ohio and across the nation in 2018

What’s new with the Common Rule? Clinical research and Common Rule updates

New cybersecurity threats with potential to impact health care industry identified

To text or not to text? CMS issues guidance

Oncology firm to pay $26 million to settle FCA allegations

Annual deadline to seek new property tax exemption approaches

DOJ announces FCA enforcement priorities at HCCA conference

CMS cuts CY 2018 payment rates to non-excepted off-campus provider-based departments

Cardiology practice settles 60-Day Overpayment case under the False Claims Act for double damages

Human subject protections in clinical research: OHRP and whistle blower protections

Ohio apology statute covers admissions of fault

Revocation 2017-31014: First revocation for failure to comply with Section 501(r)

Hospice in the government’s cross-hairs

HRSA announces 340B information system outage beginning August 15

For CY 2018, Meaningful Use reporting period is once again 90 days

Human subject protections in clinical research: Monitoring compliance with the Common Rule

National Health Care Fraud Takedown charges more than 400 defendants with $1.3 billion in false billings

AG issues advisory opinion regarding CNPs and acute care practice

Kentucky court allows on-site inspection of electronic medical records in malpractice case

Hospital fined nearly $1.3 million for multiple EMTALA violations involving psychiatric patients

TJC revises pain assessment and management requirements for accredited hospitals

ODH establishes new requirements for medical directors of adult cardiac catheterization and open heart surgery services

Recent cases spotlight research misconduct in clinical research

eClinicalWorks to pay $155 million for misrepresenting its Meaningful Use certification and making kickback payments

Ohio Supreme Court rejects “quantity of charity care” argument in property tax exemption case

CMS revises process and forms for reporting Stark Law violations

The consequences of “gun jumping” in mergers and acquisitions

Accreditation changes may cause trouble for hospital-based sleep centers

Ohio takes steps to limit prescription of opiates for acute pain

First federal court finds collection of documents meets Stark Law writing requirement

HIPAA enforcement actions highlight importance of maintaining and auditing security practices

OIG publishes Resource Guide for measuring compliance program effectiveness

As statutorily intended and judicially recognized, a negligent credentialing claim Is a medical claim

Sorry seems to be the hardest word: Ohio’s apology statute for healthcare providers

Pharmacy loyalty program results in $50 million settlement

False Claims Act: 2016 year in review and 2017 look ahead

CHNA requirements notice #6: State encourages allocation of community benefit expenditures to activities that support community health objectives

Three notable HIPAA enforcement actions in 2017

CHNA requirements notice #5: State encourages partnerships in conducting the CHNA

CHNA requirements notice #4: State encourages selection of evidence-based strategies from SHIP

CHNA requirements notice #3: State encourages inclusion of at least one core metric from SHIP in CHNA

CHNA requirements notice #2: CHNA must address at least two health priorities identified in the State Health Improvement Plan

CHNA requirements notice #1: 2017 CHNA deadlines for Ohio tax-exempt hospitals

A look behind the curtain: Life under a corporate integrity agreement for one public health care provider

Is your tax-exempt hospital ready for the 2017 CHNA deadline?

Court blocks proposed merger of insurance giants

Advanced practice registered nurses in Ohio – Major changes coming in April!

CMS issues guidance on correct use of “PN” and “PO” modifiers in hospital off-campus provider-based departments

2016 False Claims Act cases result in over $4.7 billion in recovery for Department of Justice

Micro hospital fails to meet the definition of a hospital for Medicare enrollment

Senate passes 21st Century Cures Act – Provider-based mid-build exception one step closer

2017 OPPS final rule – Generally good news for providers regarding provider-based locations

What do President-Elect Trump’s HHS and CMS picks mean for health care reform?

Plenty of activity in the health care false claims arena

2017 OIG Work Plan summary

Assessing the impact of the election on health care reform

2017 OPPS final rule – Site-neutral payments for new off campus provider-based departments

2017 OPPS final rule – Meaningful Use rules

CMS awards next round of RAC contracts

Did you know? CMS has offered to resume Medicare appeals settlements

New initiative from CMS to reduce medical record review for clinicians participating in certain Advanced Alternative Payment Models

Registries seeking to join CMS Repository for public health data must apply by October 31

CMS announces additional opportunities for clinicians to qualify as Advanced APMs under MACRA

OCR releases HIPAA guidance on cloud computing services

MACRA Final Rule solidifies new physician reimbursement model

Make sure your prescribers are in compliance with OARRS opioid prescription rules

Joint Commission accredited organizations must now provide advance written notice of significant changes

Tenet to pay over $513M for kickback scheme involving pregnant patients

Compliance deadline approaching for Section 1557 nondiscrimination requirements

Former CEO settles allegations amid further Tuomey fallout

South Carolina Medical Center pays Department of Justice $17 million to settle False Claims Act case alleging employment agreements violate Stark law

Government sends a $2.95 million warning to health care providers with announcement of settlement in 60-day overpayment rule case

CMS delays implementation of the NOTICE Act and MOON form requirement

OCR announces new plan to investigate HIPAA breaches affecting fewer than 500 individuals

OCR announces record HIPAA settlement

IRS guidance on health plan cash opt-out arrangements

Is your organization compliant with the new ACA non-discrimination final rule?

Proposed Rule Implementing Section 603 of the Bipartisan Budget Act of 2015 Dashes Hospitals’ Hopes

Caps on noneconomic damages again found to be constitutional; Affordable Care Act approved in reducing economic damages

OCR launches HIPAA Phase 2 Audits and announces deadline and focus areas

CMS proposes big changes to EHR meaningful use

CMS proposes to implement Balanced Budget Act's site-neutral payments for new off-campus provider-based departments

Penalties in health care fraud cases to nearly double on August 1, 2016

Historic multi-jurisdiction health care fraud investigation results in over 300 arrests related to $900 million in fraudulent billing

Supreme Court clarifies basis for liability under the False Claims Act

Recent false claims cases and settlements

United States House of Representatives v. Burwell: An uncertain future for cost-sharing subsidies

Does your compliance function measure up? The OIG’s revised criteria for permissive exclusion

First denial of tax-exempt status to a non-Medicare Shared Savings Program ACO

The Department of Justice alleges two hospitals unlawfully agreed to restrict marketing in each other’s primary area

U.S Department of Homeland Security issues alert on hospital ransomware attacks

Recent false claims settlements and case developments

OIG reports hospices inappropriately billed Medicare $268 million for general inpatient care

Ohio Supreme Court rules that patient medical record not defined by what is kept by hospital’s medical records department

CMS proposes increased requirements to the provider enrollment process

OCR announces launch of HIPAA Phase 2 audits

Failure to execute a BAA results in $1.55 million fine for Minnesota hospital system

Got Medicare Part A appeals? A new pilot program might be right for you!

Hospitals: Are you ready to give NOTICE?

New guidance and information from OCR and ONC on patient access to medical information

CMS releases new cycle of provider revalidations and new revalidation tools

U.S. Supreme Court deals a blow to all payer claims databases

A smorgasbord of false claims settlements to start off 2016

Hackers demand ransom from California hospital

False Claims Act: 2015 year in review and 2016 look ahead

CMS publishes final 60-day overpayment rule for self-identified overpayments

Supreme Court to rule on implied certification liability under the False Claims Act

New modifier and POS code for off-campus provider-based departments mandatory starting January 1, 2016

Medicare’s "Two-Midnight Rule” – Where are we now after all of the rulemaking?

HIPAA settlement with University of Washington Medicine highlights need for organization-wide risk analysis

Highlights of the 2016 OIG Work Plan

Employed physician arrangements in the government's crosshairs

CMS finalizes new exceptions and clarifications to Stark Law

Budget Bill Blues: The reimbursement equalization of hospital off-campus provider-based locations and independent health care facilities

CMS and OIG finalize waivers for Medicare Shared Savings Program ACOs

Ohio Medicaid adopts three-day window

Tuomey – Case closed!

The DOJ announces huge False Claims Act settlement with Adventist Health System

Finalized Stage 3 Rule means big changes for meaningful use starting in 2015, especially for hospitals

Department of Justice wins federal court ruling on 60-day overpayment rule

Two-Midnight Rule update: CMS issues proposed rule to clarify when inpatient admissions are appropriate for payment under Medicare Part A

$237 million judgment against Tuomey Healthcare upheld by federal appeals court

ICD-10: Lack of code specificity in first year will not cause claims denials

Health law subsidies upheld by the U.S. Supreme Court

OIG issues Fraud Alert to warn physicians about the risks of compensation arrangements

HHS OIG and industry leaders release joint guidance for health care boards

Physician compensation problems cost Texas hospital over $21 million

Everything you wanted to know about the “doc-fix” bill, but were afraid to ask

10 years after the Deficit Reduction Act: a look at state false claims statutes

CMS releases Stage 3 Meaningful Use proposed rule

Services performed by inappropriate staff members could lead to False Claims liability

Lessons Learned – How compliance officers can better protect their organizations (Part 5)

Lessons Learned – How compliance officers can better protect their organizations (Part 4)

CMS announces one-year delay in final 60-day overpayment rule

Lessons Learned – How compliance officers can better protect their organizations (Part 3)

Hospitals must start Medicare EHR participation in 2015 to earn incentives

Appellate Court upholds divestiture after health care system acquires large physician group

Anthem discloses largest ever health care industry cyber attack

Lessons Learned – How compliance officers can better protect their organizations (Part 2)

CMS to consider shortening meaningful use reporting period for 2015

Lessons Learned – How compliance officers can better protect their organizations (Part 1)

CMS makes big changes to RAC program

Don't let this be you: Provider agrees to a $150,000 HIPAA settlement in potential security breach matter

CMS finalizes provider enrollment safeguards and tables fraud whistleblower rewards

CMS proposes rule to strengthen accountable care organizations

HRSA withdraws proposed 340B “Mega Reg” in favor of future agency guidance

CMS extends CEHRT hardship exception deadline for eligible professionals and eligible hospitals

OIG releases the 2015 work plan

Ebola Virus Disease (EVD) preparation: Common sense planning

OIG proposes new AKS safe harbors and expands CMPs

CMS releases open payments data to the public

CMS issues new and updated FAQs related to its appeals settlement offer to hospitals

Recent false claims cases and settlements

OIG report finds noncompliance with Ohio hospice licensure requirements

OIG Audit uncovers erroneous Medicaid EHR incentive payments

New Ohio law requires informed consent for prescribing opioids to minors

CMS offers settlement to resolve appeals backlog for denials of short stay inpatient claims

Alabama health system and clinics to pay $24.5 million to settle alleged diagnostic imaging scheme

CMS and ONC finalize rule allowing options for CEHRT

Hospital system discloses HIPAA breach affecting 4.5 million individuals

Obstetric services requirement under DSH: Are your hospital’s DSH funds in jeopardy?

DOJ intervenes in False Claims Act suit over ACA’s 60-day overpayment rule

OIG proposes expansion and changes to civil monetary penalty regulations, including proposed penalty for failure to timely refund overpayments

CMS issues proposed rule to eliminate the requirement for physician certification of most hospital inpatient stays

New CMS interactive tool helps providers understand CEHRT proposed rule

Recent False Claims settlements, case developments and communications from the Office of Inspector General

$800,000 HIPAA settlement in alleged medical record dumping matter

OIG proposed rule: No statute of limitations on certain exclusion actions and other significant changes to exclusion authority

HHS sends two new HIPAA reports for 2011-2012 to Congress

Fraud takes no vacations: Summer vacation season brings new False Claims and health care fraud cases

CMS and ONC proposed rule provides 2014 CEHRT flexibility for meaningful users

CMS issues new meaningful use attestation guidelines

CMS final rule changes provider and supplier conditions of participation

$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

See All

Columbus

Cleveland

Cincinnati

Dayton

Marietta

Barnesville

Lebanon

Industries & Practices

Health Care Law

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

Related Insights

What to expect now that we’re expecting: What the end of the public health emergency means for healthcare providers Part 2: Guidance on telehealth

What to expect now that we’re expecting: What the end of the public health emergency means for healthcare providers

Are you regulated under HIPAA? Ensure your website or app’s user tracking is HIPAA compliant

Ohio Supreme Court confirms Wuerth application to medical claims

CMS restores 340B drug acquisition reimbursement

Ohio Department of Health proposes draft Health Care Service rules for comment

Malpractice does not equal murder

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

Information Blocking in 2021

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

What health care providers need to know as COVID-19 vaccines arrive in Ohio

Major changes to HIPAA Privacy Rule proposed

CMS releases Hospital 2021 OPPS final rule

Will you be ready when the COVID-19 vaccines arrive?

CMS and OIG finalize major changes to Stark and Anti-Kickback regulations: What health care entities need to know

CMS and OIG issue long-awaited final rules changing the Stark Law, Anti-Kickback Statute and Beneficiary Inducement Civil Monetary Penalty Law