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September 2020 Archives

Why should my diagnostic lab care about compliance?

Gravity Diagnostics, a CLIA diagnostic and testing laboratory licensed to provide services throughout the country, recently announced the addition of an executive. Although the addition of another executive for this large of an organization on its own is not of note, the job description for this position is: chief compliance officer. Lab owners moved to hire this executive solely for the purpose of better ensuring the lab is compliant with all applicable regulations - both state and federal.

Compliance violations and diagnostic labs: Top three violations

Lab owners must balance a multitude of tasks to have a successful business. They need to make sure they have the staff needed to run a safe, accurate and efficient facility. In addition to watching the bottom line, these entrepreneurs also need to have a basic understanding of applicable regulations. A failure to abide by these rules can result in allegations of fraud - which can come with serious penalties.

NY healthcare provider settles allegations of HIPAA violation

This past August, the United States Department of Health and Human Services (HHS) Office for Civil Rights (OCR) received a complaint that Housing Works Inc., out of New York, had failed to provide a patient with a copy of his medical records. The patient argued that the health care organization’s failure to provide the requested information was a violation of the patient’s rights under the Health Insurance Portability and Accountability Act (HIPAA). This compliant triggered an investigation. Upon facing the allegations, the healthcare provider chose to settle the claim instead of fight back.

Hospital pays $50M to settle FCA allegations

The United States Department of Justice recently announced that a hospital out of Virginia has agreed to pay $50 to settle claims that it violated the False Claims Act (FCA). This most recent settlement highlights the government's continued focus on aggressively pursuing potential health care fraud cases. The settlement was the result of a Qui Tam case originally brought by a former hospital executive. After the hospital executive initiated this lawsuit, the government chose to step in and move the case forward.

How serious are allegations of overpayment?

Medical professionals who receive a notice of overpayment from Medicare or commercial insurance companies may find themselves facing a massive bill. These letters demand repayment, sometimes asking the health care professional to pay millions of dollars back to the insurance provider. Government agents and those who work for these commercial providers will take aggressive actions to recoup these funds, potentially including invasive investigations.

Can home health care centers survive the challenges of 2020?

2020 is a year that has tested businesses in every marketplace. The home health system is no exception. This niche area of health care has had to navigate many issues throughout the year, some novel, some that have been building over the years. Two of the most notable include dealing with the decision by the Centers for Medicare and Medicaid Services (CMS) to eliminate home health pre-payments and addressing the current coronavirus pandemic.

Why are private equity firms purchasing physician groups?

The purchase of physician groups by private equity firms has soared in recent years. According to a recent publication in the Journal of the American Medical Association (JAMA), private equity firms acquired 1,426 sites and almost 6,000 physicians from 2013 through 2016. Multispecialty and anesthesiology practices make up the largest portion, at 19% each, followed by emergency medicine at 12%, family practice at 11% and dermatology at 10%. Recently, increases are also noted in the fields of radiology, obstetrics/gynecology, ophthalmology and cardiology.  

What happens if a nurse fails to disclose a prior arrest?

Working to get a nursing degree is no easy task. It takes countless hours of study, practical experience and the sacrifice of time otherwise spent with family and loved ones. When getting to those final stages of the process, when close to having everything complete that is needed to start a job as a nurse, an applicant must first apply with the local nursing board to get a nursing license in the state they choose to practice their profession.

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