11th Circuit Awards Humana Double Damages Under Medicare Secondary Payer Act

Posted in Health Insurers & Managed Care Organizations, Healthcare Law, Healthcare Litigation, Medicare & Medicaid

Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436.

Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights Medicare itself would have in actions against primary payers for reimbursement of conditional healthcare treatment costs.  Continue Reading

HHS Issues Final Non-Discrimination Rules for Healthcare Providers

Posted in Affordable Care Act and Other Healthcare Reform Legislation, Healthcare Law, Hospitals & Health Systems

Healthcare providers and others who receive federal financial assistance are now subject to new non-discrimination rules and notice requirements under the Affordable Care Act. The new regulation prohibits discrimination in healthcare programs and activities on the basis of race, color, national origin, age, disability and sex – including pregnancy, gender identity, and sex stereotyping. The new rule also encompasses the obligation to provide language assistance services free of charge to persons with limited English proficiency. Continue Reading

Brief Reprieve Before Hospitals Must Provide Medicare Patients with “Observation” Notices

Posted in Healthcare Law, Hospitals & Health Systems, Medicare & Medicaid

Hospitals now have additional time before they must meet federal requirements to provide written notice to Medicare patients who are receiving observation services. Congress passed the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) in 2015, in response to patient confusion and complaints related to hospital observation stays. The rules were expected to be effective in August 2016. The Centers for Medicare and Medicaid Services (CMS) announced on August 2, 2016, that hospitals will have to begin delivering notices effective October 1, 2016. Continue Reading

Illinois’ Largest Health System Agrees to Stringent HIPAA Breach Settlement

Posted in HIPAA, Privacy, and Data Security, Hospitals & Health Systems

The Department of Health and Human Services Office for Civil Rights (OCR) announced on August 4, 2016, a settlement agreement with Advocate Health Care Network, an integrated healthcare system with ten hospitals and a non-profit medical group of more than 1,500 physicians in Illinois (the System or Advocate). The System agreed to adopt a corrective action plan and to pay $5.5 million to settle potential HIPAA violations related to three separate data breach incidents in 2013. The settlement is the largest to-date by OCR with a single entity. Continue Reading

Anti-Discrimination, Language Access Rules Compliance Deadline Fast Approaching for Health Insurers

Posted in Affordable Care Act and Other Healthcare Reform Legislation, Health Insurers & Managed Care Organizations

Health insurers and HMOs have a limited time to review the new federal meaningful access rules and amend plan documents accordingly. However, many payors still have not revised their plans to include the required language, and others might not be aware the rules apply to them. Continue Reading

Insurers Challenge Retroactive Application of New Florida Law that Requires Comparison of Names of Accounts to Death Master File

Posted in Government Affairs, Licensure & Regulatory, Health Insurers & Managed Care Organizations

Amendments to the Florida Disposition of Unclaimed Property Act in 2016 made significant changes to unclaimed property presumptions and insurance company obligations. See § 717.107, Fla. Stat. (2016) (the Act). Among other things, the Act: (a) revises conditions of when certain insurance policies or annuity contracts are deemed matured and the proceeds are due and payable; (b) requires  insurance companies to compare their records of life or endowment insurance policies, annuity contracts, and retained asset accounts against the United States Social Security Administration Death Master File (DMF) to determine whether a death is indicated, to update certain records, and to remit to the State of Florida any unclaimed funds within five years after a policyholder’s date of death; and (c) provides for a presumption of death for individuals whose names are contained in the DMF. Importantly, the Act specifies that it is remedial and applies to all policies entered into after July 1, 1992. Ch. 2016-219, § 2, Laws of Fla. (2016).  Continue Reading

Breach or No Breach – OCR Weighs in on Ransomware

Posted in HIPAA, Privacy, and Data Security

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) released its much-anticipated guidance on ransomware (OCR Ransomware Guidance) this week in response to a number of highly publicized attacks targeting the healthcare sector. Ransomware is a type of malicious software that encrypts data, making it inaccessible until the data owner pays a ransom. The OCR Ransomware Guidance describes how healthcare organizations can prevent such attacks and how such attacks may come within the ambit of HIPAA. Continue Reading

Business Associates Beware! OCR Is Coming For You

Posted in HIPAA, Privacy, and Data Security

Last week, the U.S. Department of Health and Human Services Office for Civil Rights (OCR) announced the first HIPAA settlement involving a business associate. Catholic Health Care Services of the Archdiocese of Philadelphia (CHCS), a nonprofit organization that provides management and information technology services to six wholly-owned skilled nursing facilities, agreed to pay $650,000 and enter into a corrective action plan to settle potential violations of HIPAA arising out of the theft of a CHCS-issued smartphone.  The phone was not encrypted or password protected and contained detailed and sensitive health information of over four hundred nursing home residents. Continue Reading

What does the Escobar Decision Mean for Healthcare Providers?

Posted in Fraud & Abuse & False Claims Act, Healthcare Law

Universal Health Services, Inc. v U.S. ex rel. Escobar

On June 16, 2016, the U.S. Supreme Court in Universal Health Servs., Inc. v. United States ex rel Escobar, No. 13-317, — S. Ct. — (June 16, 2016), confirmed that the implied certification theory may serve as a basis for liability under the False Claims Act (FCA), although it employed a more narrow interpretation of the theory than the lower court. The Court’s unanimous ruling can be summarized as follows: Continue Reading

Medical Marijuana’s Florida Debut: A Process Fraught with Constraints

Posted in Government Affairs, Licensure & Regulatory, Healthcare Law

Florida’s limited medical marijuana program is finally almost ready to go live. For those who have been sitting on the sidelines waiting for the right moment to learn about the program, now is that moment. Recently, the Florida Department of Health (DOH) hosted a webinar highlighting some of the key features, as well as limitations of the program. The smoking of cannabis is not authorized under the law and therefore no smokable product will be dispensed. Vapor pens and cartridges containing cannabis oil will likely be most prevalent. Below are the highlights of the DOH webinar: Continue Reading

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