Archives: Hospitals and Health Systems

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W2 Phishing Scam Hits Citizens Memorial Hospital

We continue to see all industries hit with W2 phishing scams, including the health care industry.

Citizens Memorial Hospital, located in Bolivar, Missouri, was hit with the scam when one of its employees believed that an email received from another employee was legitimate, and sent the W2s of its employees from 2016 to a hacker. Usually, the W2s are used by the hackers to then file false tax returns seeking a quick tax refund before the taxpayer files his or her return.

Employees continue to fall victim to the scheme …

$5.5 Million HIPAA Settlement Emphasizes Importance of Audit Controls of Access by OHCA Affiliates

On February 16, 2017, the Office for Civil Rights (OCR) announced a $5.5 million settlement with South Broward Hospital District d/b/a Memorial Healthcare System (Healthcare System), to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  The Healthcare System is a nonprofit corporation that operates several hospitals, an urgent care center, a nursing home, and ancillary health care facilities throughout south Florida.  The Healthcare System is also affiliated with physician offices through an Organized Health Care Arrangement (OHCA).…

Appeal Filed in Case Ordering HHS to Reduce Backlog of ALJ Appeals

The Secretary of the U.S. Department of Health & Human Services (HHS) has appealed a ruling by United States District Court Judge James E. Boasberg that had required HHS to make substantial reductions in its current backlog of cases pending before Administrative Law Judges (ALJ) (Notice of Appeal, U.S. Court of Appeals, District of Columbia Circuit, Case No. 17-5018).  In his Memorandum Decision filed December 5, 2016, Judge Boasberg had ordered HHS to achieve a 30% reduction in the current backlog of cases pending at the ALJ level by December …

TCPA Violations Claimed Against San Diego Hospital

Rady Children’s Hospital-San Diego (Hospital) was hit with a proposed class action in California federal court this week for alleged violations of the Telephone Consumer Protection Act (TCPA) for autodialed debt-collection calls to consumers’ cell phones. The complaint states that “[the Hospital], either directly or through their agents, illegally contacted plaintiffs and the class members via their cellular telephones by using an ATDS [(i.e.,an automated telephone dialing system)], thereby causing plaintiffs and the class members to incur certain cellular telephone charges or reduce cellular telephone time for which plaintiffs and …

CMS Final Rule on Episode Payment Models and Revisions to CJR Model

In December, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (Final Rule) implementing new and revised episode payment models (EPMs) developed by the CMS Innovation Center.  The Final Rule continues CMS’ transition of Medicare payment methodologies away from fee-for-service and towards value-based payments, including by incentivizing care coordination efforts and tying payments to quality improvement.

New EPMs:  The Final Rule implements three new EPMs for episodes of care surrounding (i) acute myocardial infarction (AMI); (ii) coronary artery bypass graft (CABG); and (iii) surgical hip/femur fracture treatment …

Medicare Shared Savings Program (MSSP) Track to Incentivize Assumption of Risk

On December 20, 2016, CMS announced the formation of a new participation track under the Medicare Shared Savings Program (MSSP) – the Medicare ACO Track 1+ Model – which will start in 2018. Accountable care organizations (ACOs) participating in this model will agree to accept more limited downside risk than ACOs participating in Track 2 or Track 3 of the MSSP, and will be eligible to share up to 50% of savings from care provided to a prospectively assigned beneficiary population. This model will qualify as an Advanced Alternative Payment …

OIG’s 2016 Report on Provider-Based Facilities

On June 16, 2016, the Office of Inspector General (OIG), Department of Health and Human Services, issued a report on the Centers for Medicare & Medicaid Services’ (CMS) oversight of provider-based facilities.  In the report, the OIG concluded that although CMS is taking steps to improve its oversight, vulnerabilities nevertheless remain.

As part of its Bipartisan Budget Act of 2015, Congress had eliminated provider-based status for new off-campus outpatient departments of a provider. The Centers for Medicare & Medicaid Services’ (CMS) provider-based rules currently allow a hospital or health system …

CMS’s Mandatory Bundled Payment Program for Lower Extremity Joint Procedures

In January 2016, the Centers for Medicare & Medicaid Services (CMS) finalized the somewhat controversial, mandatory Comprehensive Care for Joint Replacement Model (CJR Model), which is a bundled payment program covering certain orthopedic procedures reimbursed by Medicare. The final rule implementing the CJR Model is effective on January 15, 2016, and the first model performance period begins on April 1, 2016. With the CJR Model, CMS aims to align various providers’ financial incentives by establishing a bundled payment system for CJR Procedures conducted in acute care hospitals located in 67 …

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