The Office for Civil Rights (“OCR”) has selected Ashburn, Virginia-based FCi Federal to conduct the next round of HIPAA audits mandated by the HITECH Act. OCR views the audits as a compliance tool that will hopefully get out in front of industry problems before they happen. This round is different than …
When Is a Hospital Not a Hospital?
July 30, 2015 Leave a Comment
When is a hospital not a hospital? The Fifth Circuit provided an answer in a July 29 decision in favor of a nurse seeking insurance coverage for medical treatment at a residential treatment facility. Rebecca was a nurse at North Cypress Medical Center, in Texas. Back in 2011 she was treated for an eating …
Bill Would Extend CMPs to Federal Grants
July 7, 2015 Leave a Comment
The bill known as the “21st Century Cures,” H.R.6, would extend Civil Monetary Penalties (CMPs) to cover false claims and false statements relating to grants, contracts, and other agreements funded by the Department of Health & Human Services (HHS). Falsehoods relating to clinical trials appear to be a …
Insurer Escapes Antitrust Suit, But Hospital Must Continue the Fight
June 2, 2015 Leave a Comment
A large regional health insurer extricated itself from an antitrust suit, leaving the dominant local hospital to square off alone versus an ambulatory surgical center (ASC). The U.S. District Court for the Southern District of Illinois dismissed exclusive dealing allegations against BlueCross and BlueShield of …
All or Nothing: Federal Court Decides Exclusion from ‘Some’ Patients Insufficient for Refusal to Deal Claim
May 1, 2015 Leave a Comment
A federal district court in the Eighth Circuit dismissed claims brought against a physician-hospital organization and an insurer alleging that the defendants violated federal antitrust laws by refusing to deal with certain providers. An ambulatory surgery center (ASC) and two physicians asserted that the …
Insurer’s Agreements with Providers Are Not Per Se Antitrust Violations
March 6, 2015 Leave a Comment
The Iowa Supreme Court refused to categorize a health insurer’s agreements with providers in Iowa and its participation in the national Blue Cross and Blue Shield (BCBS) network as per se violations of the antitrust laws. In its decision in Mueller v. Wellmark, Inc. issued on February 27, 2015, the court …