Justice Department Charges Hundreds in False Billing Schemes

More than 400 people, including doctors, pharmacists and nurses, have been charged in connection with a massive health care fraud scheme that cost the federal government of more than $1.3 billion, federal officials announced Thursday.

Read more at: http://www.ocregister.com/2017/07/13/hundreds-ensnared-in-justice-department-health-care-fraud-crackdown-on-1-3-billion-in-false-billings/amp/.



Posted on July 14, 2017 .

CMS Proposes Rule That Would Remove The Ban On Pre-Dispute Arbitration Agreements in Long Term Care

n June 8, 2017, the Centers for Medicare & Medicaid Services ("CMS") published a proposed rule that would remove the ban on pre-dispute arbitration agreements established in 2016. Under the new proposed rule, long term care facilities may enter into pre-dispute arbitration agreements as long as certain transparency requirements are met. CMS also proposes to remove the provision banning long term care facilities from requiring residents to sign arbitration agreements as a condition of admission.

Read more at: http://www.jdsupra.com/legalnews/cms-proposes-rule-to-reverse-pre-17362/

Posted on June 16, 2017 .

No Business Associate Agreement? A $31,000 Mistake.

On April 20, 2017, the Office for Civil Rights (OCR) announced that the Center for Children’s Digestive Health (CCDH) paid $31,000 to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy rule. The settlement was initiated as a part of a compliance review following an investigation of a business associate, FileFax, Inc. FileFax stored records containing protected health information (PHI) for CCDH.

The investigation by the OCR revealed that the parties began sharing PHI since 2003 but neither party could produce a signed Business Associate Agreement (BAA) prior to October 2015.

The OCR has been reinforcing BAA requirements and has issued settlements with providers totaling $23 million in 2016. The Catholic Health Care Services of the Archdiocese of Philadelphia (CHCS) paid $650,000 as a settlement in 2016 as a result of lacking necessary BAAs. CHCS provided services to six skilled nursing facilities and the OCR received notification from each facility that a mobile device was stolen, potentially compromising 412 individuals' information. CHCS was found to have lacked the necessary BAA and did not conduct an accurate and thorough risk assessment of the potential risks and vulnerabilities of electronic protected health information (ePHI).

A BAA is not optional under HIPAA rules and regulations.  If you have a vendor who performs certain functions involving PHI/ePHI you must have a signed BAA in place to comply with the requirements under OCR.

Posted on May 10, 2017 .

New Form For CMS Voluntary Self-Referral Disclosure Protocol

CMS issued a new Self-Referral Disclosure Protocol (SRDP) Form that provides a streamlined and standardized format for disclosing actual or potential violations of the physician self-referral law. The SRDP Form will reduce the burden on providers and suppliers submitting disclosures to the SRDP and facilitate our review of the disclosures.

Use of the form is mandatory effective June 1, 2017. Parties submitting self-disclosures to the SRDP are encouraged, but not required, to use the SRDP Form now. Visit the SRDP webpage to learn more.

Posted on April 6, 2017 .

Compliagent's CEO, Nick Merkin, Guests on a Special Episode of Healthicity's Podcast Series Entitled, "An Attorney Talks Compliance."

Nick Merkin, CEO of Compliagent, chats with compliance expert CJ Wolf from his office in sunny California about compliance from an attorney’s perspective.  

Merkin explained why it’s so important for organizations to see compliance from an attorney’s perspective. And how his unique point of view provides an additional layer of protection from compliance violations. In this compelling interview, Merkin explains how organizing compliance functions is, “worth its weight in gold.”

Tune in to this podcast, An Attorney Talks Compliance, to find out how to:

  • Focus Compliance on Processes and Infrastructure

  • Organize Compliance Functions to Protect Against Litigation

  • Mitigate Legal Liabilities That Might Arise in Healthcare

Click here to listen and

to see compliance from an attorney’s perspective

Posted on April 3, 2017 .

Florida Court Imposes $347 Million in Treble Damages in SNF False Claims Act Whistleblower Case

On March 1, 2017, a Florida federal court imposed more than $347M in treble (three times) damages following a jury trial in a False Claims Act case. The four defendants operated 53 skilled nursing facilities and allegedly submitted false claims to Medicare and Medicaid. 

The whistleblower for the case was a former nurse at two of the facilities . The particular allegations involved submitting false claims and fraudulent records to substantiate the false claim asserting that patients needed and received more care than was necessary. 

Read more here: http://blog.providertrust.com/blog/false-claims-act-court-triples-whistleblower-damages

Posted on March 21, 2017 .

Memorial Healthcare System Enters Into $5,500,000 Settlement with OCR for Alleged HIPAA Violations

Memorial Healthcare System reported to OCR that the PHI of 115,143 patients had been impermissibly accessed by its employees and impermissibly disclosed to affiliated physician office staff. This information consisted of the affected individuals’ names, dates of birth, and social security numbers. 

Read the Resolution Agreement and Corrective Action Plan, as well as OCR's Press Release concerning the settlement here: 


Posted on March 17, 2017 .