Author Archives: Charles Dunham
Proposed Rule to Extend and Amend the Exception to Donate Electronic Health Records Items and Services
The Office of Inspector General for the Department of Health and Human Services (OIG) and the Centers for Medicare and Medicaid Services (CMS) published on April 10, 2013 proposed rules to extend and amend the Electronic Health Records (EHR) donation … Continue reading
HIPAA Enforcement for Breach Involving Less than 500 Patients
The U.S. Department of Health and Human Services (HHS) initiated a compliance investigation after the Hospice of North Idaho (HONI) reported to HHS that an unencrypted laptop computer containing the electronic protected health information (ePHI) of 441 patients had been … Continue reading
New York State Legislative Bill Mandating Direct Payment To Out Of Network Clinical Laboratory Providers
The New York State Senate and Assembly have introduced a bill (S.1083/A.636) to amend the Public Health Law (Section 4406) and the Insurance Law (Section 4084), in relation to reimbursement of out-of-network clinical laboratory providers by a commercial health benefit … Continue reading
Quest’s Competitors File Lawsuit for Prohibited Arrangements with National Health Plans
Over the past several years, some commercial insurers have made a concerted effort to reduce costs associated with laboratory services, which physicians have increasingly relied upon in diagnosing and treating patients. In particular, insurers are concerned with the rise in … Continue reading
False Claims Act: Payment vs. Participation Regulations
In U.S. ex rel. Williams v. Renal Care Group, Inc. (Case No. 11-5779) (October 5, 2012), the Sixth Circuit Court of Appeals reversed a grant of summary judgment in favor of the United States on two main False Claims Act … Continue reading
HIPAA: Conversion to Version 5010
As of January 1, 2012, all healthcare providers were required to transition from version 4010/4010A to version 5010 standards for submitting electronic transactions, and the failure to comply may result in claim denials or a government investigation. CMS has repeatedly … Continue reading
New York State’s Efforts to Reform Out-of-Network Payments
The New York State Legislature introduced a bill (S.5068A/A.7489B) to address benefit coverage for out-of-network care by health insurers. The stated purpose of the bill is to protect enrollees that purchase premiums to permit choice and cover the cost of … Continue reading
CMS Releases Proposed Rules for Reporting and Returning Medicare Overpayments for Parts A and B
The Centers for Medicare & Medicaid Services (CMS) released proposed rules (42 C.F.R. Part 401, Subpart D) for Medicare overpayments to implement section 6402(a) of the Affordable Care Act enacted in 2010. The Act requires that overpayments be reported and … Continue reading
HHS Selects 32 Organizations for the Pioneer ACO Model
The U.S. Department of Health and Human Services (HHS) recently selected 32 Accountable Care Organizations (ACOs) to participate in the Pioneer ACO Model designed by the CMS Innovative Center to test the impact of several innovative payment arrangements to support … Continue reading
PHHPC Passes Emergency Rule to Lift Moratorium on CHHA
The Public Health and Health Planning Council (PHHPC) of the New York State Department of Health (DOH) approved an emergency rule that will lift the State’s moratorium on accepting applications for new Certified Home Health Agencies (CHHAs) since 1994. The … Continue reading
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