Compliance Update

Getting the Vax Facts

Despite two years of COVID and a year’s worth of vaccinations, there remains some confusion over the privacy of an employee’s vaccination status. As a healthcare employer, are you permitted to ask your employees if they’re vaccinated? Do you breach the Health Information Protection and Accountability Act (HIPAA) in doing so? The quick answers to those questions are: it’s OK for an employer to...

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Substance-induced Disorders may be Incorrectly Supported

From time to time, we run into risk adjusted conditions that are “newly discovered” by coders without fully applying the diagnostic criteria. Those conditions are then suggested to providers, who may not be up on the requirements for the condition and who may report them incorrectly. As we’ve blogged countless times before, the goal of risk adjusted payments is to correctly fund the care of...

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Pharmacy Enforcement Remains Top Priority

Pharmacies and pharmacists continue to be a top enforcement priority for the U.S. Department of Justice and the myriad healthcare fraud task forces around the country. Recent Sentencing in Compounding Pharmacy Fraud Case Last month, a Mississippi pharmacist was sentenced to 5 years in prison for defrauding TRICARE (the government healthcare payer for the U.S. military and veterans) and some...

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Healthcare Fraud Scheme Indictment Starts the New Year

The U.S. Attorney arrested 13 people in a $100 Million healthcare fraud scheme in NY and NJ involving automobile insurance claims. Some of the facts alleged include— Bribed 911 operators and hospital employees for confidential information of insured drivers Unnecessary and painful medical procedures A non-physician owning medical clinics Paying hundreds of thousands of dollars to “runners” who...

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The On-Again, Off-Again Vax Mandate

If those of us in healthcare are having a tough time keeping straight whether the mandates are on or off, imagine the rest of the country! As of this writing, they are on. Kind of. Feel free to read through an earlier blog and its information sources for a timeline, but in a nutshell, there are two mandates. OSHA’s ETS is aimed at employers with 100+ employees and requires both doses of the...

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No Surprise Billing Requirements to be Implemented Jan 1, 2022

On January 1, 2022, a new federal law, “Requirements Related to Surprise Billing, Part I” (“The Rule”), goes into effect for health care providers and facilities and for providers of air ambulance services. The Rule will restrict excessive out-of-pocket costs to consumers which resulting from surprise billing and balance billing. Group health plans and health insurers contract with a network of...

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