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HHS

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OIG Policy Update: Excluding Participation in Federal Healthcare Programs

On April 16, 2016, the Office of Inspector General of the Department of Health and Human Services (OIG) issued a revised policy statement updating its criteria on excluding individuals/entities from participation in Medicare, Medicaid, and all other Federal healthcare programs. This policy statement is an update to the 1997 statement and provides insight into the OIG’s

Overpayments: Reporting and Returning Deadline

The long awaited ruling on reporting and returning overpayments is now in the Federal Register and will become effective on March 14, 2016. As stated in §401.303, an overpayment is any fund that a person has received or retained under Title XVIII of the Social Security Act to which the person, after applicable reconciliation, is

Compliance Program: What is the Value?

The value placed on a compliance program varies greatly with perspective and remains difficult to define. Obviously, the purpose of a compliance program is to prevent and deter wrongdoing. A strong program preempts problems. However, it is difficult to know what might happen in the future or what could have gone wrong in the past.

HIPAA Privacy Rule Changes Address Gun Control

On January 4, 2016, the Obama administration rolled out a number of executive actions addressing gun control, one of which impacts the Health Insurance Portability and Accountability Act (HIPAA). To this end, the Department of Health and Human Services (HHS) issued a final rule narrowly modifying the HIPAA Privacy Rule to allow certain covered entities

Individual’s Rights to Access PHI

An individual’s right to access their protected health information (PHI) should be nothing new to covered entities. In 1996, HIPAA Privacy Rule detailed an individual’s right to access PHI. As part of HITECH and the Final Omnibus Rule, modifications to the Privacy Rule have included additional requirements for covered entities and business associates. Unfortunately, recent

Deadline for Breach Reporting Coming Soon

As the end of the year approaches, keep in mind that all breaches of unsecured protected health information involving less than 500 individuals must be reported to the Secretary at the Department of Health and Human Services (HHS) within 60 days of the end of the calendar year. If the organization already reported a breach

OIG WORKPLAN 2016

The Office of the Inspector General (OIG) is responsible for protecting the integrity of the programs in Health and Human Services against fraud, waste and abuse as well as recommending improvements to the system that would promote efficiency and efficacy within the limits of the health care laws.   Although OIG oversight includes programs such as

Overview of a Corporate Integrity Agreement (CIA)

Health care fraud recoveries for fiscal years 2009- 2014 exceeded previous records with five straight years of more than $2 billion in annual recovery from cases involving fraud and false claims against federal health care programs such as Medicare and Medicaid.  Most healthcare providers are aware of significant civil liability due to recent enforcement. However,

Are You Prepared for the HIPAA Phase 2 Audits?

After reviewing the HIPAA Privacy case investigations from 2009-2011, the Office of the Inspector General sent a strong message to the Office of Civil Rights in regard to the administration and enforcement of the HIPAA Privacy Rule. The OIG recommendation is clear in the September 2015 executive summary, “OCR Should Strengthen Its Oversight of Covered

What is the Wall of Shame?

As part of HITECH, any breach of over 500 individuals will be posted on “The Wall of Shame” on the HHS website. It is important for covered entities to be aware of the necessary steps to avoid joining this list and to become familiar with the HITECH Breach Notification Protocol in the case of a