On May 29, 2012 the United States District Court for the Eastern District of North Carolina overturned the Medicare Appeals Counsel’s (MAC’s) decision regarding one evaluation and management (E/M) service claim. Six years earlier, a CMS Program Safeguard Contractor audited Dr. Ojebuoboh. It was determined that the government had overpaid…
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HHS Releases Memo to Consumers Highlighting HIPAA Rights to Access Health Records
On May 31, 2012, Department of Health and Human Services (HHS) Director of the Office of Civil Rights Leon Rodriguez issued a memo to consumers regarding those consumers’ right to access their protected health information and medical records. In this memo, Rodriguez stressed that it is important for consumers and…
State AG HIPAA Training Materials Available Online
The Office of Civil Rights (OCR) announced yesterday that its Health Insurance Portability and Accountability Act (HIPAA) Enforcement Training tools would be available to the general public today, June 5, 2012. Since 2009, as part of the Health Information Technology for Clinical and Economic Health (HITECH) Act, State Attorneys General…
Knowledge of Illegality Not Required For Criminal Charges Under HIPAA
On May 10, 2012 the United States Court of Appeals for the Ninth District decided that criminal charges under the Health Insurance Portability and Accountability Act (HIPAA) do not require that an individual have knowledge that their actions are illegal. The case, United States of America v. Zhou, is the…
CMS Provides List of Providers Who Need to Revalidate Their Medicare Enrollment
As part of healthcare reform, Section 6401(a) of the Affordable Care Act requires all providers and suppliers who enrolled in the Medicare program prior to March 25, 2011 to revalidate their provider enrollment under the new screening criteria. Providers and suppliers who enrolled after March 25, 2011 do not need…
CMS Delays Implementation of Physician Payments Sunshine Act
On May 3, 2012, the Centers for Medicare and Medicaid Services (CMS) announced, via the CMS blog, that CMS will not require data collection by applicable manufacturers and group purchasing organizations under the Physician Payments Sunshine Act (PPSA) before January 1, 2013. The announcement indicates that the final rule will…
CMS Publishes Final Rule With New Provider and Supplier Requirements
On April 27, 2012 the Centers for Medicare and Medicaid Services (CMS) published a final rule that states new provider and supplier requirements. The final rule requires all providers and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all enrollment applications for Medicare or…
GAO Report Examines CMS Efforts to Strengthen Screening
From July 2011 to February 2012 the Government Accountability Office (GAO) conducted a performance audit of the Centers for Medicare and Medicaid Services (CMS) efforts to strengthen the screening of providers and suppliers applying to take part in, and currently taking part in, the Medicare and Medicaid programs. On April…
OIG Releases Its Updated List of Excluded Individuals and Entities
On April 12, 2012, the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) published an updated list of excluded providers, persons and entities from Medicare, Medicaid and other Federal health care programs, known as the List of Excluded Individuals and Entities (LEIE). HHS is…
HHS Announces Proposed Rule to Simpify the Administrative Process for Health Care Providers
Yesterday, the Department of Health and Human Services (HHS) announced a proposed rule that would simplify the administrative processes for health care providers by establishing a unique health plan identifier (HPID) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HHS estimates that the HPID would save the…