The final rule under HIPAA, released this past January, makes some sweeping changes that will greatly enhance a patient’s privacy rights. Now, a “business associate” also includes a subcontractor that creates, receives, maintains, or transmits protected health...
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MEDPAC Recommends Small Rate Increase for Hospitals
According to MEDPAC (The Medicare Payment Advisory Commission, an independent congressional agency), hospitals served their Medicare patients at a 5.8% loss in 2011, down from a 4.5% loss in 2010. This was mainly because of the reduction in 2011 payment rates for...
Fraud Alert for PODS
The U.S. DHHS Office of Inspector General Has Issued a Fraud Alert for PODS The Office of Inspector General (OIG) for HHS has issued a Special Fraud Alert regarding Physician-Owned Distributorships (PODs) that sell surgical implants. The POD does not manufacture the...
Exclusion and Sanction Databanks
While searches of the National Practitioner Data Bank (NPDB), the Healthcare Integrity and Protection Databank (HIPDB), System for Award Management (SAM) and State databases can and should be used in addition to HHS’s Exclusion database, they are...
Deficient Services Finding Can Be a Basis for a False Claims Suit
In United States v. Houser and Houser, a 2011 federal criminal court case from Northern Georgia, the United States levied criminal False claim indictments against the Housers for billing for nursing home services that the government claimed were so “deficient” that to...
Hospice CAP Calculation Election Under CMS Ruling 1355-R is Permanent and Applies to All Following Years
When one “elects” to have the statutory Patient by Patient Proportional method used in determining the CAP for payment by Medicare for hospice services in a cost reporting year, that election is permanent and the hospice CAP will be calculated by that method for all...
The Improvement Standard Under Jimmo v. Sebelius
For decades, Medicare beneficiaries, mainly those with long-term or debilitating conditions or those who need rehabilitation services have been denied necessary care based on the “Improvement Standard.” This is an illegal practice by CMS and its contractors that has...