Hospitals


Sutter Health to Pay $45 Million for Stark Law Violations
November 22, 2019 | Eric D. Fader | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on November 15 that Sutter Health, a northern California health system, agreed to pay a total of $45.6 million to settle allegations that it violated the Stark Law in submitting claims to Medicare for services. Sacramento Cardiovascular Surgeons Medical Group Inc. (Sac Cardio), whose physicians referred patients to Sutter, also …
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HHS Releases Price Transparency Rules
November 21, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
On November 15, the U.S. Department of Health and Human Services (HHS) announced the release of two healthcare price transparency rules. One is a final rule requiring hospitals to make available online all standard charges for items and services, including discounted rates negotiated with third-party payers. The second is a proposed rule that would require …
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NY Hospital Pays $3 Million HIPAA Settlement
November 6, 2019 | Eric D. Fader | Electronic Health Records | HIPAA | Hospitals | Litigation
The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced on November 5 that the University of Rochester Medical Center (URMC) agreed to pay $3 million to settle violations of the HIPAA Privacy and Security Rules. URMC is one of the largest health systems in New York State, with more than …
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Primary Care Payment Model Delayed to 2021
November 4, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
The Center for Medicare & Medicaid Innovation, part of the Centers for Medicare & Medicaid Services, recently released its Request for Applications for the new “Primary Care First” payment model. The program will now begin in 2021 rather than the 2020 start date that was originally proposed in April, as discussed here. CMS said it …
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Hospital to Pay $20 Million to Settle Whistleblower Case
October 29, 2019 | Eric D. Fader | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medical Devices and Wearables | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on October 28 that Sanford Health, a hospital in Sioux Falls, South Dakota, will pay $20.25 million to settle a whistleblower lawsuit alleging violations of the False Claims Act and federal Anti-Kickback Statute. Two surgeons at the hospital filed the suit alleging that the hospital allowed another surgeon …
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Florida Hospital Fined $2.15 Million for Theft and Sale of Records
October 24, 2019 | Ada Kozicz | Electronic Health Records | HIPAA | Hospitals | Litigation
The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced on October 23 that Jackson Health System (JHS) in Miami has received a civil money penalty of $2,154,000 for violations of HIPAA’s Security and Breach Notification Rules. OCR Director Roger Severino said, “OCR’s investigation revealed a HIPAA compliance program that had …
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NY DFS Proposes “Surprise Bill” Amendment
October 15, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Private Insurers
On October 10, the New York State Department of Financial Services released a proposed amendment to the state’s Out-of-Network Law. If approved, the amendment would require insurance companies and healthcare providers to comply with several new requirements to better protect consumers from “surprise” medical bills. Insurers that receive a claim for services rendered by a …
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FCA Ruling: Proof of Falsity Needed to Show Fraud
September 16, 2019 | Geoffrey R. Kaiser | False Claims Act | Fraud and Abuse | Hospitals | Legislation and Public Policy | Litigation | Medicare and Medicaid
Last week, the 11th Circuit Court of Appeals handed down its long-awaited decision in United States v. AseraCare, Inc. The case, brought under the False Claims Act (FCA) and argued way back in March 2017, alleged that AseraCare, a for-profit multi-state hospice chain, had submitted false claims to the Medicare program for patients who were …
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Tech Giants Continue Healthcare Advances
September 11, 2019 | Eric D. Fader | Electronic Health Records | Hospitals | Medical Devices and Wearables | Telehealth
Mayo Clinic announced a 10-year strategic partnership with Google that aims to “accelerate the pace of health care innovation through digital technologies.” Mayo Clinic intends to use advanced cloud computing, data analytics, machine learning and artificial intelligence (AI) to improve its delivery of care, including, for example, using AI-enabled digital diagnostics to advance virtual care. …
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HIPAA Access Violation Results in Settlement
September 10, 2019 | Eric D. Fader | Electronic Health Records | HIPAA | Hospitals | Litigation
The U.S. Department of Health and Human Services (HHS) announced on September 9 that Bayfront Health St. Petersburg (Bayfront), a 480-bed Florida hospital, has paid HHS’s Office for Civil Rights (OCR) $85,000 to settle a potential violation of HIPAA’s right of access provisions. Bayfront’s Resolution Agreement with HHS also provided for the company to enter into a one-year …
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