Disclosures for Specific Payment or Health Care Operations Purposes (§ 2.33)

Part 2 Records –  Specific Payment or Health Care Operations Purposes (§ 2.33) Special restrictions apply to health information that is restricted under SAMHSA rules.  These rules protect patient information involving substance and alcohol treatment in Federal programs.  SAMHSA requirements...

Authentication of Verbal Orders by Other Responsible Practitioner

Prompt Authentication of Verbal Orders ; Verbal Order Risks The failure of a physician to timely sign a verbal order can have reimbursement implications. In some cases, in some states, another responsible provider can sign a verbal order that is originally given by another practitioner. This opti...

Telemedicine Compliance Series – Licensing Issues in Telehealth

How Telemedicine Licensing Issues Arise – Compliance for Telehealth Programs The practice of medicine is licensed and regulated at the state level.  The jurisdiction of individual states over medical licensure is broadly recognized by the courts and the federal government, including CMS.  The f...

Failing to Perform an Electronic Access Risk Analysis Before and Unauthorized Access Occurs

OCR Settlement Lessons – No Risk Assessment Exposes Provider to Liability Failure to conduct a risk assessment before a hacking incident occurred resulted in a $400,000 settlement between OCR and a Federally Qualified Health Clinic.  The FQHC filed a breach report upon learning that its employee...

Designated Health Services Definition I Stark Law DHS Defined

Definition of Designated Health Services under the Stark Law Regulations Designated health services (DHS) means any of the following services (other than those provided as emergency physician services furnished outside of the U.S.), as they are defined in this section: (1)(i) Clinical laboratory ...

Can Overpayments Create Criminal Liability?

We hear a lot about potential liability under the False Claims Act (FCA) for the failure to repay overpayments within 60 days of discovery. Focus on the 60-day rule has taken focus away from the potential for criminal charges for retaining known overpayments.  Section 1128B(a)(3) of the Social S...

Defining the Duty of the Board of Directors over Compliance Functions

Compliance Program Oversight by Board of Directors I recently posted a blog article about a document released by the Department of Justice entitled “Evaluation of Compliance Programs.”  As the title of the document might suggest, the DOJ release covers a variety of issues it looks at when ev...

Self Disclosure Process – Voluntary Self Disclosure Decisions are not Always Easy

Provider Self Disclosure Decisions – Voluntary Disclosure Process The HHS Office of Inspector General offers providers and opportunity to self-disclose certain violations in exchange for avoiding some of the more draconian penalties that may otherwise apply under applicable regulations.  Even ...