Having a compliance program in place is a start but having an effective compliance program is the goal. Proactively assessing the effectiveness of one’s own compliance program is better than the Department of Justice making a determination of the adequacy as a result of an investigation for alleged misconduct. To set benchmarks for an effective
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
The whistleblower provisions of the False Claims Act have lead to several newsworthy cases in recent years. Just a few days ago, the Justice Department announced that KMART Corporation (Kmart) will pay $1.4 Million to resolve False Claims Act allegations for knowingly providing coupons to Medicare beneficiaries to waive or reduce co-pays for purchasing more
The treatment of family members falls under General Exclusions from Coverage under Medicare. No payment will be made for items or services for a family member when the charge is from an immediately related provider, any of their associates or their professional corporations. As part of Stark I in 1989, self-referrals for clinical laboratory services
As the world of healthcare evolves, more and more healthcare providers are turning to mobile devices in their practice. If you are a covered entity, you are responsible for complying with HIPAA regulations for securing private patient information, including when using mobile devices. Here are some guidelines to ensure security while using mobile devices: Before
As technology continues to evolve, so does social media, with more and more platforms arising for people to communicate – anytime, anyplace to anyone. The increase in social media presence in healthcare creates greater vulnerability toward breaches of patient confidentiality. Here are some tips to avoid violating HIPAA with social media: Do not talk about
Audits and investigations are stressful events either with or without prior notice. Medical staff should be prepared for an unannounced visit. First Healthcare Compliance provides a sample policy that assists clients in preparing the front office. Here are some recommendations to ensure that proper steps are taken: Immediately contact your supervisor, manager and/or Compliance Officer
An increasingly important issue for many providers is the dilemma of providing care that is satisfactory to the patient while avoiding overutilization and its effect on reimbursement. Unfortunately, the patient’s perceived satisfaction may not be a result of receiving the best quality of care and in some cases may be due to inappropriate or wasteful
Obviously, no one wants to terminate a patient, but sometimes it is reasonable and in the best interest of both parties. There are circumstances when it may be within the rights of the provider and appropriate to terminate a patient. Some examples include a patient who: -No-shows or cancels appointments frequently or repeatedly -Does not
Medical identity theft continues to be major problem in the US with approximately 2.32 million adults or close family members falling victim in 2014. According to the Fifth Annual Study on Medical Identity Theft by the Ponemon Institute, medical identity theft is on the rise with a 21.7% increase since last year.
