Eric Fader contributed to Healthcare Risk Management’s HIPAA Regulatory Alert, which appeared in the publication’s December 2019 issue. The Alert outlines the best practices that will help avoid common HIPAA violations. Eric discusses the events that might trigger a regulatory action and the kinds of violations that may affect the severity of the penalties and fines.

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

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

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

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

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

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

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

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

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.