Pennsylvania Hospital and Cardiology Group Agree to Pay $20.75 Million to Settle Allegations of Kickbacks and Improper Financial Relationships

UPMC Hamot, a hospital based in Erie, Pennsylvania and Medicor Associates Inc., a regional physician cardiology practice, have agreed to pay the government $20,750,000 to settle a False Claims Act lawsuit alleging that they knowingly submitted claims to the Medicare and Medicaid programs that violated the Anti‑Kickback Statute and the Physician Self‑Referral Law.   

Read more at: https://www.justice.gov/opa/pr/pennsylvania-hospital-and-cardiology-group-agree-pay-2075-million-settle-allegations

Records of 135,000 Patients May Have Been Compromised in the Second Largest HIPAA Breach of 2018

A malware infection at St. Peter’s Surgery & Endoscopy Center in New York has potentially allowed hackers to gain access to the medical records of as many as 135,000 patients.

Read more here: https://www.hipaajournal.com/new-york-surgery-endoscopy-center-discovers-135000-record-data-breach/.

OIG's 2019 Budget Request Spurs Preparation for More Acute Healthcare Enforcement

The OIG emphasized the impact of more sophisticated data analytics in its 2019 budget request. 

Read more here: https://www.fiercehealthcare.com/aca/oig-budget-data-analytics

Some Experts Warn That Medical Devices Might be Vulnerable to a Remote Hacking Attack

Expoerts discuss the vulnerabilities of heart implants, insulin pumps, and other medical devices.  Read more here:  

https://www.webmd.com/heart-disease/news/20180220/could-hackers-target-heart-devices#1

Consequences for HIPAA violations don’t stop when a business closes

A receiver appointed to liquidate the assets of Filefax, Inc. has agreed to pay $ 100,000 out of the receivership estate to the to settle potential HIPAA violations. Even closing the business didn't allow it to avoid fines and penalties. 

Read More Here:

https://www.hhs.gov/about/news/2018/02/13/consequences-hipaa-violations-dont-stop-when-business-closes.html

Memphis rehabilitation center to pay $500K for providing 'worthless' services

On February 5, 2018, McKnight’s Long-Term Care News reported, “Spring Gate Rehabilitation and Healthcare Center in Memphis will pay $500,000 to federal authorities and Tennessee to resolve false claims allegations.

“The Department of Health and Human Services' Office of Inspector General alleged that from 2012 to 2015, Memphis Operator LLC, doing business as Spring Gate, provided substandard and ‘worthless’ nursing home services to residents, care deemed so deficient it can't be claimed through Medicare or the state's Tenncare program.

“The allegations were first raised in a False Claims Act lawsuit brought by a whistleblower, according to a news release. The OIG intervened in the case and Spring Gate cooperated to reach a resolution.”

 READ MORE

CMS Clarifies Its Texting Rules for Healthcare Providers and Organizations

After a December  18, 2017 HCCA report that CMS had sent emails to at least two hospitals saying that even secure text messaging applications were not permitted, CMS recently clarified its position on texting for healthcare providers and organizations.

Pursuant to a December 28, 2017 letter, CMS explained that it "recognizes that the use of texting as a means of communication with other members of the healthcare team has become an essential and valuable means of communication among the team members."

The letter further stated that "in order to be compliant with the CoPs or CfCs, all providers must utilize and maintain systems/platforms that are secure, encrypted, and minimize the risks to patient privacy and confidentiality as per HIPAA regulations and the CoPs or CfCs. It is expected that providers/organizations will implement procedures/processes that routinely assess the security and integrity of the texting systems/platforms that are being utilized, in order to avoid negative outcomes that could compromise the care of patients.”

A copy of the CMS letter can be found here: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-10.pdf.

Compliagent's COO, Paige Pennington, Addresses New Regulatory Developments in LTC Discharge and Transfer Requirements at the National ACO, Bundled Payment & Readmission Summit

On October 26, 2017, Compliagent's COO, Paige Pennington, delivered a talk regarding new regulatory developments in LTC discharge and transfer requirements at the National ACO, Bundled Payment & Readmission Summit (Part of the 2017 NRPC C-Suite Invitational Series) at the California Endowment Conference Center in Los Angeles, California.  

Call or email us for more information about how these changes may impact your facility -- 310-996-8950; info@compliagent.com.

Some States Fell Short in Timely Investigation of the Most Serious Nursing Home Complaints between 2011-2015

 

On September 29, 2017, the Office of Inspector General (OIG) released a report finding that some states fell short in timely investigation of the most serious nursing home complaints between 2011-2015. Under federal and state regulations, CMS relies on individual states’ respective state survey agencies to address various types of concerns raised by residents, family members, and nursing home staff. Such concerns include residents admitted to the hospital because of preventable infections, residents left sitting in their urine and feces for hours, and inappropriate social media posts by employees.

State agencies must conduct onsite investigations within a certain period of time for the most serious level of complaints. Previous reports by the OIG found that state agencies often did not conduct onsite investigations within the required time frame, which requires that immediate jeopardy cases be investigated within two working days and that non-immediate jeopardy-high priority cases be investigated within 10 working days.

OIG Results

The OIG found that during 2011-2015, while the number of nursing home residents decreased overall, the number of nursing home complaints state agencies received increased 33 percent (47,279 to 62,790). The report also found that, in 2015, both Tennessee and Georgia received a total of 912 immediate jeopardy complaints, which accounts for 17% of all immediate jeopardy complaints. Out of 912 complaints, 654 (71%) were investigated late. Additionally, across all five years, Arizona, Maryland, New York, and Tennessee accounted for almost half of the high priority complaints not investigated onsite within 10 workings days. Furthermore, almost one-quarter of states did not meet CMS’s annual performance threshold for timely investigations of high priority complaints in all four years and all states substantiated almost on third of the most serious nursing home complaints.

Overall, the OIG data report offers Centers for Medicare and Medicaid Services some insights into the states that have room for improvement in prioritizing and responding within the required time frame to nursing home complaints. The OIG will continue to monitor the oversight of nursing homes and will initiate additional reviews as necessary.

National Partnership to Improve Dementia Care Achieves Goals to Reduce Unnecessary Antipsychotic Medications in Nursing Homes

On October 2, the National Partnership to Improve Dementia Care announced that it met its goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 30 percent by the end of 2016. It also announced a new goal of a 15 percent reduction by the end of 2019 for long-stay residents in those homes with currently limited reduction rates. Nursing homes with low rates of antipsychotic medication use are encouraged to continue their efforts and maintain their success.

For More Information:

·         Fact Sheet

·         National Partnership to Improve Dementia Care in Nursing Homes webpage