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HIPAA Fines, Mobile Devices and Risk Assessments: Follow the Steps or Pay the Price

By Lance O. Leider, J.D., The Health Law Firm

Two separate entities have agreed to pay the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) $1,975,220 in fines collectively. The settlements resolve potential violations of the Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules involving stolen, unencrypted laptops. These two actions shine a light on the significant risk unencrypted laptops and other mobile devices pose to the security of patient information.

To read the press release from the HHS OCR, published on April 22, 2014, click here.

Concentra Received Risk Assessments, But Did Not Act on Findings.

According to the OCR, an investigation of Concentra Health Services, a subsidiary of Humana, was conducted after a laptop was stolen from a Missouri physician therapy center. This investigation revealed that Concentra had previously received […]

California Doctor To Pay $562,500 Fine and Spend 5 Days in Jail for Balance Billing Patients Covered by Managed Care Plans

By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A California doctor was fined $562,500 and ordered to spend five days in jail for illegally balance billing patients covered by health plans, according to a Los Angeles Times posted in December 2013. The doctor, Jeannette Martello, M.D., is a plastic and reconstructive surgeon practicing in the Los Angeles area. She was accused of balance billing patients covered by managed care health plans that were provided emergency treatment in several hospitals in Los Angeles. The doctor had very aggressive collection practices and allegedly sued her patients frequently to collect the fees not covered by the managed care health plans.

Click here to the entire Los […]

Florida Attorney General Targets Targeted Case Management Fraud

By Christopher E. Brown, J.D., The Health Law Firm

Due to increased fraud throughout the system, the Florida Attorney General (AG), through the Medicaid Fraud Control Unit (MFCU), is focusing its attention on Medicaid targeted case management (TCM) services.

TCM services were created to assist children with documented mental health conditions in gaining access to medical, social, educational, and other support services. To be eligible for such services a child must meet very strict criteria.

Eligibility Criteria for Children’s Mental Health TCM Services:

1. Must be enrolled in a Department of Children and Families (DCF) children’s mental health target population (birth through 17 years);
2. Has a mental health disability (i.e., serious emotional disturbance) that requires advocacy for and coordination of services to maintain or improve level of functioning;
3. Requires services to assist in attaining self sufficiency and satisfaction in the living, learning, work, and […]

By The Health Law Firm|2024-03-14T10:00:56-04:00June 1, 2018|Categories: Medicaid, Medicaid Fraud Control Unit, The Health Law Firm Blog|Tags: Attorney General (AG), DCF, defense attorney, defense lawyer, Department of Children and Families, false claims, falsified records, florida attorney, Florida lawyer, Florida Medicaid, Florida Medicaid Program, fraudulent claims, health law firm, medicaid, medicaid audit, Medicaid claims, Medicaid fraud, medicaid fraud control unit, Medicaid fraud defense attorney, Medicaid fraud defense lawyer, Medicaid investigation, Medicaid targeted case management, mental health TCM services, mfcu, services never rendered, TCM, the health law firm|Comments Off

Doctors’ Medicare Payment Data to be Released Spring 2014

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

For years, the Centers for Medicare and Medicaid Services (CMS) has kept private its records on Medicare claims payments made to individual physicians. However, beginning March 18, 2014, the government may disclose the payment data on a case-by-case basis. According to CMS, this directive is a push by the Obama Administration to crack down on doctors who are making a habit out of repeatedly overcharging Medicare. On January 15, 2014, CMS stated that recalcitrant providers could face civil fines and exclusion from Medicare and other federal health care programs. According to CMS, a recalcitrant provider is defined as one who is abusing the program and not changing inappropriate behavior even after extensive education to address these behaviors.

Data Made Public to Fight Healthcare Fraud.

According to […]

By The Health Law Firm|2024-03-14T10:00:54-04:00June 1, 2018|Categories: Health Care Industry, Medicare, The Health Law Firm Blog|Tags: Centers for Medicare and Medicaid, CMS, defense attorney, defense lawyer, doctor attorney, doctor lawyer, doctor payment information, doctors, exclusion from Medicare, expelled from Medicare, health law firm, improper payments, internal medicine, medically necessary claims, medically unnecessary claims, medicare, Medicare abuse, Medicare doctor services, Medicare fraud, Medicare payment data, Medicare payments, Medicare physician services, ophthalmology, overcharge Medicare, physician attorney, physician lawyer, physician payment information, physicians, radiation oncology, Recalcitrant providers, the health law firm|Comments Off

What Happens in the VA System Has Implications for all Health Care Professionals; FBI Investigates VA

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Veterans Administration healthcare system is at a crossroads. After the recent revelations about long wait times for veterans and systematic cover-ups, it is clear that reforms in the Veterans Health System are needed.

On June 11, 2014, the Federal Bureau of Investigation (FBI) announced it has opened a criminal investigation of the Department of Veterans Affairs (VA). The investigation stems from allegations that officials with the VA have been manipulating medical waiting lists and delaying care for thousands of veterans. On the same day, the U.S. Senate approved a bill that would allow veterans who experience long delays for appointments or live far away from a VA facility to get care at nearby private hospitals and medical facilities. In addition the bill would provide […]

Dermatology Practice Settles with Government After Stolen USB Drive Results in HIPAA Breach

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR), and Adult & Pediatric Dermatology (APDerm), reached a $150,000 settlement for privacy and security violations of the Health Insurance Portability and Accountability Act (HIPAA). The alleged violations related to an unencrypted USB drive that was stolen. The thumb drive contained the protected health information (PHI) of around 2,200 patients, according to a press release posted December 26, 2013, on the HHS website.

According to the HHS, this is the first settlement with a covered entity for not having policies and procedures in place to address the breach notification provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

To read the entire press release from the HHS, […]

By The Health Law Firm|2024-03-14T10:00:54-04:00June 1, 2018|Categories: HIPAA, Hitech Act, The Health Law Firm Blog|Tags: corrective action plan (CAP), data security, defense attorney, defense lawyer, Health Information Technology for Economic and Clinical Health (HITECH) Act, Health Insurance Portability and Accountability Act (HIPAA), health law firm, HIPAA attorney, HIPAA compliance, HIPAA compliance audit, HIPAA lawyer, HIPAA risk assessment, medical history, medical records, Office of Civil Rights (OCR), Omnibus Rule, Omnibus rule compliance deadline, Patient privacy, patient records, privacy, protected health information (PHI), the health law firm, U.S. Department of Health and Human Services (HHS)|Comments Off

CMS in the Hot Seat for Lax Oversight of Medicaid Managed Care Organizations

By Lenis L. Archer, J.D., M.P.H., The Health Law Firm

For years, each state has kept an eye on its own Medicaid managed care plans, while the Centers for Medicare and Medicaid Services (CMS) is required to monitor how well each individual state is doing. However, a recent Government Accountability Office (GAO) report claims CMS is sleeping on the job. The report, released on June 20, 2014, stresses the need for more federal oversight of these plans.

With the implementation of the Affordable Care Act (ACA), the Medicaid program is expected to expand significantly. Most of the new beneficiaries enrolled in managed care are covered almost entirely by federal funds. The need for federal oversight in this area is of growing importance to ensure accountability of taxpayers’ dollars.

To read the entire report from the GAO, […]

By The Health Law Firm|2024-03-14T10:00:57-04:00June 1, 2018|Categories: Department of Health and Human Services, GAO, Government Accountability Office, Health Care Industry, HHS, In the Know, In the News, MCO, Medicaid, Medicaid managed care, Medicare, The Health Law Firm Blog|Tags: ACA, Affordable Care Act, auditing payments to MCO, Centers for Medicare and Medicaid Services, CMS, CMS oversight, Department of Health and Humans Services, GAO investigation, health law firm, hhs, improper payments, managed care insurance, managed care plan, managed care services, MCO managed care, medicaid, Medicaid defense attorney, Medicaid defense lawyer, Medicaid managed care organization, Medicaid payments, Medicaid programs, Patient Protection and Affordable Care Act, the health law firm|Comments Off

Some Providers Billing PIP Claims No Longer Exempt From Health Care Clinic Act

By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law

Some health care providers that were previously exempt from the requirements of the Health Care Clinic Act are now required to obtain a Health Care Clinic license in order to bill for care provided to their patients injured in car accidents.

The original purpose of the Health Care Clinic Act was to regulate health care entities that were not owned by licensed health care providers. Entities that were owned by licensed health care providers were exempt from the Health Care Clinic license requirements because those health care providers were already regulated by the Department of Health (DOH).

Effective January 1, 2013, the law changed so that every health care provider that bills personal injury protection (PIP) insurance carriers is now required to obtain a Health Care Clinic license unless […]

Why Have You Received a Denial on Your Medicare Enrollment Application?

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Did you receive a denial on your Medicare enrollment application and can’t figure out why? You may be surprised to find out that even the smallest punctuation error, such as a missing comma or period, could be the reason Medicare rejected your application.

The Centers for Medicare and Medicaid Services (CMS) will deny Medicare applications of physicians, medical groups, home health agencies (HHAs), pharmacies and durable medical equipment (DME) suppliers because the name on file with the National Plan & Provider Enumeration System (NPPES) is not the same legal business name as reported to the Internal Revenue Service (IRS). The use of punctuation marks and abbreviations in your name with NPPES could produce a no match […]

By The Health Law Firm|2024-03-14T10:00:57-04:00June 1, 2018|Categories: Health Care Industry, Medicare, The Health Law Firm Blog|Tags: Centers for Medicare and Medicaid Services, CMS, defense attorney, defense lawyer, health law firm, medicare, Medicare enrollment, Medicare program, Medicare Provider Enrollment Chain and Ownership System, Medicare provider number, National Plan & Provider Enumeration System (NPPES), NPI Registry, PECOS, request for reconsideration, termination of Medicare billing privileges, termination of Medicare provider number, the health law firm|Comments Off

Florida Respiratory Therapist Arrested for Alleged Elder Abuse

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A Lee County, Florida, registered respiratory therapist at HealthPark Medical Center in Fort Myers, Florida, was arrested and charged with battery on an elderly patient. The respiratory therapist was arrested by the Attorney General’s (AG) Medicaid Fraud Control Unit (MFCU). The arrest was announced by the AG on February 14, 2014.

To read the news release from the AG, click here.

Respiratory Therapist Accused of Fracturing Patient’s Hand.

According to the AG, the respiratory therapist allegedly abused a 68-year-old intensive care unit patient by severely bending his fingers back resulting in a bone fracture in the patient’s hand, while the man’s arms were restrained.

The respiratory therapist is charged with battery on a person over the age of 65, which is a third-degree felony. If […]

By The Health Law Firm|2024-03-14T10:00:55-04:00June 1, 2018|Categories: Medicaid Fraud Control Unit, The Health Law Firm Blog|Tags: Attorney General (AG), battery charges, battery charges on a health care professional, defense attorney, defense lawyer, elder abuse, florida attorney, Florida lawyer, health law firm, medicaid fraud control unit, Medicaid Fraud Control Unit investigation, mfcu, R.R.T., registered respiratory therapist, respiratory therapist, the health law firm|Comments Off