The final rule under HIPAA, released this past January, makes some sweeping changes that will greatly enhance a patient's privacy rights. Now, a “business associate” also includes a subcontractor that creates, receives, maintains, or transmits protected health information on behalf of another business associate. Contracts between business associates and business associates that are subcontractors are also required…Read more
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According to MEDPAC (The Medicare Payment Advisory Commission, an independent congressional agency), hospitals served their Medicare patients at a 5.8% loss in 2011, down from a 4.5% loss in 2010. This was mainly because of the reduction in 2011 payment rates for inpatients. MEDPAC also postulates that “efficient” providers, defined by a set of hospitals with good…Read more
The U.S. DHHS Office of Inspector General Has Issued a Fraud Alert for PODS The Office of Inspector General (OIG) for HHS has issued a Special Fraud Alert regarding Physician-Owned Distributorships (PODs) that sell surgical implants. The POD does not manufacture the device, but merely acts as the distributor between the manufacturer and the physician. The OIG…Read more
While searches of the National Practitioner Data Bank (NPDB), the Healthcare Integrity and Protection Databank (HIPDB), System for Award Management (SAM) and State databases can and should be used in addition to HHS’s Exclusion database, they are not a substitute. Adequate exclusion screening can only be done by including the List of Excluded Individuals/Entities (LEIE). Because the LEIE…Read more
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