NY Watchdog Releases Its Annual Fraud Fighting Plan

The New York State Office of the Medicaid Inspector General (OMIG or agency) has recently issued its 2017-2018 Workplan. The Workplan identifies key areas of OMIG’s focus impacting health care providers and suppliers.

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Late Breach Notification Leads to Half a Million Dollar HIPAA Settlement

Failure by a covered entity to timely report a breach of protected health information (PHI) resulted in the first of its kind settlement in the amount of $475,000.

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OIG 2016 Workplan: Is It Time To Check Your Compliance?

Every year the Office of the Inspector General (OIG) issues a workplan that identifies the agency’s planned audit activities for the upcoming year. The workplan offers valuable information for healthcare entities by providing them with an opportunity to conduct appropriate risk assessments, and, where indicated, to modify the entity’s compliance program.

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$6.49 Billion Paid to Doctors by Medical Manufacturers in 2014

The Centers for Medicare & Medicaid Services (CMS) published full year of 2014 financial data about transfers of value by drug and medical device makers to health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion.

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Another HIPAA Settlement With a Pharmacy for $125,000

The Office of the Civil Rights (OCR) within the US Department of Health and Human Services recebtly settled a HIPAA violation case with a single location compounding pharmacy in Denver, Colorado. This is yet another HIPAA settlement underscoring the importance of properly implementing and maintaining a compliance plan.

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Which New York Providers Need a Compliance Program?

New York State Social Service Law §363-d and implementing regulations at 18 NYCRR §521 require that certain healthcare providers adopt and implement an effective compliance program and certify their compliance with the law every December.

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HHS OIG Releases 2014 Work Plan

Every year the U.S. Department of Health and Human Services Office of the Inspector General (OIG) publishes a work plan that provides industry stakeholders with insight as to the OIG’s new and ongoing auditing and investigative activities in the upcoming year.

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Who is a Business Associate under HIPAA?

Last year’s passing of the new HIPAA requirements signaled the government’s concern that individually identifiable health information needs stronger protection beyond the borders of the healthcare industry. HIPAA already recognized this need by imposing obligations on covered entities and their business associates in prior versions of the rule. In the latest rule update, however, the US Department of Health and Human Services, among other things, expanded the definition and responsibilities of business associates and now made them directly liable for HIPAA noncompliance.

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Annual Medicaid Certification Requirement

It’s that time of the year when qualifying providers enrolled with the NYS Medicaid Program must certify that they have a adopted, implemented and maintained an effective mandatory compliance program. The NYS Office of the Medicaid Inspector General (OMIG) is tasked with responsibility of overseeing that providers meet this requirement.

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Did You Know About New Physician Payment Transparency Program?

Section 6002 of the Affordable Care Act requires manufacturers of pharmaceuticals, biologicals, medical devices or supplies to publicly report payments made to physicians and teaching hospitals. This article reviews some of the implications the new requirement has on physicians and their relationships with the industry.

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New Hazard Communication Requirements From OSHA

Last year the Occupational Safety and Health Administration (OSHA) adopted a new OSHA Hazard Communication Standard. The new standard is now aligned with the United Nations’ Globally Harmonized System of Classification and Labeling of Chemicals. All dental and medical providers, pharmacies and other healthcare employers must comply the Hazard Communication Standard as well as other applicable OSHA standards.

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Sunshine Act Worries Some Providers

Section 6002 of the Affordable Care Act (a.k.a. “Sunshine Act”) imposes new reporting requirements on financial relationships between medical and pharmaceutical makers and physicians and teaching hospitals. While lauded for its attempts to bring greater transparency to industry financial relationships some wonder whether the implementation methods planned by the Centers for Medicare & Medicaid Services (CMS) would expand the Act beyond the boundaries envisioned by Congress.

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OIG Recoveries and Exclusions Rise in 2011

Recently, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) calculated the savings its programs brought to the Federal government in 2011. The statistics, which reveal recoveries in the billions, serve as a sobering reminder to providers of the increasing interest by the government in ensuring that providers are complying with the healthcare laws and regulations.

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Core Elements of New York Medicaid Compliance Program

This is the third and final article in the series evaluating the NYS Medicaid Compliance Program requirements. The previous two articles looked at those providers required to have a compliance program under the law and the annual certification requirement. In this article, we examine the core elements of a compliance program.

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NYS Medicaid Compliance Program: Annual Certification Requirement

This is our second article in a series discussing the New York State Medicaid’s compliance program requirements. In our first article we focused on which providers are required by law to have a compliance program. In this article, we turn our attention to the annual certification requirement.

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Mandatory Compliance Program for New York’s Healthcare Providers

The necessity of having a compliance program is no longer a requirement providers can ignore. In the next series of articles, we briefly address the compliance program requirements for New York State Medicaid providers, starting with the overview of the regulations below.

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HHS Seeks To Delay ICD-10 Implementation Date

Yesterday the Department of Health and Human Services announced a proposed rule that would delay the implementation of the International Classification of Diseases, 10th Edition, diagnosis and procedure code (ICD-10) from October 1, 2013 to October 1, 2014. The proposed rule is in response to providers’ concerns about meeting HHS’ compliance deadline for Version 5010

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Annual OSHA Check-Up

Most healthcare providers are aware of the need to comply with the Occupational Health And Safety Act (OSHA) to assure, so far as possible, safe and healthful working conditions for their office staff. Here is a quick checklist of the annual OSHA requirement:

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Compliance Corner: OSHA Written Standards and Annual Training

You have patients in the waiting room, two patients in exam rooms, your receptionists has a question for you, and right as your cell phone goes off, your assistant is asking you about a prescription. And when the sun sets, you are returning calls to patients and colleagues. OSHA compliance may not be at the

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New York’s Medicaid Provider Compliance Program

The New York State Social Service Law and its implementing regulations require that Medicaid providers develop, adopt and implement effective compliance programs aimed at detecting fraud, waste, and abuse in the Medicaid program. These programs are mandatory for those providers operating under Article 28 or 36 of the Public Health Law and Articles 16 or

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