One can argue that value-based care is clearly in the patient’s best interest. Such arrangements allow for the patient to receive care from multiple specialists and reduce the financial burden that may come with visiting more than one physician. However, lawmakers...
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How can healthcare execs defeat a whistleblower claim?
The federal government has a system in place that encourages current and former healthcare employees to report wrongdoing. This is achieved through qui tam, or whistleblower cases. The government benefits from this system because workers within healthcare...
3 ways HIPAA could change in 2021
The United States Department of Health and Human Services (HHS) recently recommended the government consider making a number of modifications to the Health Insurance Portability and Accountability Act (HIPAA). HHS states the recommendations are part of the agency’s...
Feds gain momentum with EKRA as doc takes plea deal
A group of medical professionals recently accepted plea deals in connection to a healthcare fraud scheme that operated through the country. The group had operations set up in multiple states, including New Jersey, Maryland, California. According to feds, the group...
Gov’t increases focus on healthcare fraud and telehealth services
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has increased its focus on healthcare fraud schemes involving telehealth services. The OIG began this increased focus in 2016. These efforts contributed to a massive takedown in...
Study finds errors in HRRP leading to faulty penalties
The Centers for Medicare and Medicaid Services (CMS) oversees the Hospital Readmissions Reduction Program (HRRP). Lawmakers developed this program to help better ensure the provision of quality, value-based care. To help achieve this goal, the HRRP reviews...
What does my medical practice need to know about HIPAA violations?
The Health Insurance Portability and Accountability Act (HIPAA) applies to sensitive patient health information. Medical practitioners are wise to understand how this federal law impacts their practice. Three important facts about this law include: #1: Not everyone is...
Whistleblower begins FCA case against dentist
A former employee recently filed a claim against a dentist. In this claim, the worker does not allege that they were personally injured. In fact, the claim does not even directly involve the worker. Instead, the claim states the dentist and oral surgeon fraudulently...
Lessons from record setting HIPAA fine
The United States Department of Health and Human Services (HHS) recently announced a $6.85 million settlement with Premera Blue Cross, a private health insurance provider, to settle claims the company violated the Health Insurance Portability and Accountability Act...
Is my physician group patient-centric?
The term patient-centric is a popular, sometimes overused, catch phrase within the healthcare industry these days. Although overuse is problematic, there is value to reviewing your practice’s business plan to make sure the culture provides a positive patient...