As its days dwindle down, the Trump administration proposed regulatory changes designed to ease prior authorization rules and improve provider and patient access to medical records. Specifically, the … [Read more...]
Utilization Management
CMS Proposes New Regulations to Streamline and Speed Up Payor Prior Authorization
January 4, 2021
Enforcement Trends: OCR Continues to Crack Down on HIPAA Right of Access Violations
February 27, 2020
On Sept. 9, 2019, the Office for Civil Rights (OCR), the HHS agency in charge of federal HIPAA enforcement, did something it had never done before by entering into a monetary settlement with a … [Read more...]
COMPLIANCE PLANS
OIG Monthly Work Plan Review: April 2019
May 6, 2019
Among the 10 new Work Plan items this month, three may have potential ramifications for at least some labs. Medicaid Managed Care Organization Denials Issue: The State Medicaid agency and the … [Read more...]
WHISTLEBLOWERS
Case of the Month: Facing 3 against 1, Texas Lab Settles EHR Consulting Kickback Charges
March 25, 2019
Question: What happens when multiple whistleblowers bring separate qui tam lawsuits against a lab for the same offense? Answer: Under the False Claims Act (FCA), only the first whistleblower to … [Read more...]
EHR
Enforcement Trends: Whistleblowers Get in on the EHR “Meaningful Use” Action
February 7, 2018
Wrongful payment of electronic health records (EHR) "meaningful use" incentives has become a growth area in government health fraud enforcement. (See GCA, July 10, 2017). And now private … [Read more...]
ENFORCEMENT
EHR: Private Whistleblowers Getting in on “Meaningful Use” Crackdown
February 5, 2018
Wrongful payment of electronic health records (EHR) "meaningful use" incentives has become a growth area in federal health care fraud enforcement. And now private whistleblowers are getting … [Read more...]
FOCUS ON
EHR: Window Closes on Meaningful Use Exemptions as Congress Seeks to Make Future Compliance Easier
November 6, 2017
October has been a big month for meaningful use compliance. Oct. 1: Deadline "Hardship" Exemption Among the victims of the recent natural disasters are first-time participants in the … [Read more...]
TOP OF THE NEWS
Consortium Releases New Interoperability Standard for Lab IT Systems
August 28, 2017
With the release of a new information technology (IT) standard, the dream of true interoperability of electronic health care information has gotten one step closer to reality. The new standard, called … [Read more...]
OIG REPORT
CMS Dished Out $729.4 Million in Wrongful EHR Incentive Payments & We’re Going to Get that Money Back
July 10, 2017
Wrongful payments of Electronic Health Records (EHR) incentives are at the focus of two of the month's biggest stories in health care compliance. The first came down on May 31 when the Justice … [Read more...]
CASE OF THE MONTH
The eClinicalWorks EHR Settlement—Big Fines & Unprecedented CIA Obligations
June 29, 2017
With all the money it generates, it was only a matter of time before Electronic Health Records (EHR) technology got caught up in the False Claims Act dragnet. (See the related story on EHR … [Read more...]
