In last week’s decision in Doe v. Guthrie Clinic, Ltd., the Second Circuit Court of Appeals certified to the New York Court of Appeals the issue of whether a medical corporation may be liable for the unauthorized disclosure of medical information, when the employee responsible for the breach was not a physician and was
Out-of-Network Billing – New Hope for Patients
Unexpected bills to patients for out-of-network medical care have been a problem for years. Patients, their providers – both in and out-of-network – and the insurance carriers (the “payors”) have likely been involved at one time or another in the sometimes messy situation triggered by an out-of-network provider submitting a claim for charges. Payors have
Essential Health Coverage Benefits – The ACA Final Rule
The U.S. Department of Health and Human Services (HHS) has issued final rule stating the future health insurance exchange (“Exchange”) and insurance issuer standards related to coverage of essential health benefits (EHB) and actuarial value. The final rule further establishes a timeline for when qualified health plans (QHPs) should be accredited in federally facilitated Exchanges.
New Breach Notification Requirements Released
The US Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) released final rules on January 17, 2013 governing the privacy and security of protected health information under HIPAA and the HITECH Act. The new rules take effect March 26, 2013; compliance is expected by September 23, 2013. This post will focus
“Affordable” Health Coverage Under Obama Care
As Chris Kutner explained in his January 4, 2013 post, the Patient Protection and Affordable Care Act of 2010 (“PPACA” or “Obama Care”) requires, beginning in 2014, that employers with 50 or more full-time employees (“large employers”) offer “affordable” health insurance to their employees. Failure to do so will subject the employer to penalties.
Obama Care Employer Mandates: Who Must Comply?
The Patient Protection and Affordable Care Act of 2010 (“PPACA” or “Obama Care”) requires, beginning in 2014, that employers with 50 or more full-time employees (“large employers”) offer “affordable” health insurance to its employees. Failure to do so will subject the employer to penalties.
Future blog postings will address the coverage requirements and penalties under
First HHS Settlement for Small HIPAA Breach
On January 2, 2013, the US Department of Health and Human Services announced a $50,000 settlement with Hospice of North Idaho for a data breach involving the theft of a lost, unencrypted laptop computer containing the health information of 441 patients.
This settlement is the first for a reported breach affecting fewer than 500 individuals.
Compliance Certifications Due By 12/31
Just a reminder to New York State Medicaid providers that certifications under the NYS Social Services Law and the Federal Deficit Reduction Act are due no later than December 31.
All New York State Medicaid providers who are required to have a compliance program under Social Services Law Section 363-d must certify that their compliance
New York Hospitals Continue to Struggle: Interfaith Files for Bankruptcy
On December 2, 2012, Interfaith Medical Center, Inc. (“Interfaith”) filed for chapter 11 bankruptcy protection in the United States Bankruptcy Court for the Eastern District of New York, becoming the latest New York hospital to fall victim to the current economic downturn. It remains to be seen whether Interfaith will be able to
Department of Justice Announces Record-Setting Year of False Claims Act Recoveries
Earlier this week, the Department of Justice announced that it had recovered nearly $5 billion in settlements and judgments under the False Claims Act in fiscal year 2012. The $4.959 billion figure was a new record for a single year, eclipsing the previous one-year record by $1.7 billion.
In breaking down the $5 billion in