Blog Posts: Healthcare
Despite signing a Corporate Integrity Agreement (CIA) with the government less than three years ago, Novartis Pharmaceuticals Corp. continued to engage in practices violating the Anti-Kickback Statute, federal prosecutors have alleged. The U.S. Department of Justice is seeking damages and civil penalties for the corruption of the drug-dispensing process, as detailed in a whistleblower lawsuit filed by a former sales representative in January 2011. According to the government's complaint, Novartis gave multi-million-dollar kickbacks to doctors and fraudulent rebates and discounts to pharmacies, resulting in millions of dollars in overpayments from Medicare and Medicaid.
Affordable Care Act To Go Full Strength in 2014
After epic congressional battles and a pivotal Supreme Court ruling upholding the law, the Affordable Care Act (ACA) — signed into law in March 2010 — remains a source of confusion and/or misinformation for many Americans. Most are not aware of what benefits the ACA provides or when certain changes are scheduled to occur. While many provisions are already in place, some of the biggest reforms will not take effect until the start of next year.
In 2012, the Department of Health and Human Services (HHS) audited select healthcare organizations for compliance with the Health Insurance Portability and Accountability Act (HIPAA). The agency’s findings revealed some common privacy and security mistakes among both large and small organizations:
The term “big data” refers to sets of information so large that they are difficult to process using traditional database techniques. The healthcare industry has recently started using big data to solve many issues affecting patient care. Big data is able to increase the quality of healthcare — while simultaneously lowering the cost — by revealing certain patterns and trends that would otherwise be unavailable to healthcare providers.
The Obama administration has made combating healthcare fraud a priority, encouraging employees with knowledge of such fraud within their organizations ("whistleblowers") to come forward and opening a record number of new healthcare fraud cases. In 2011, the federal government broke all records, bringing in nearly $2.3 billion in whistleblower settlements and judgments and prosecuting 417 whistleblower cases, compared with 231 in 2008.
On January 17, 2013, the U.S. Department of Health and Human Services ("HHS") issued a final rule ("Omnibus Rule") that affects multiple aspects of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). The Omnibus Rule expands privacy, security, enforcement standards and breach-notification requirements, and it implements several changes to the law made by the HITECH Act of 2009.
The Department of Health and Human Services (HHS) Office of Civil Rights (OCS) recently announced that a small non-profit hospice has agreed to pay $50,000 to settle potential HIPAA-HITECH security-rule violations arising from a breach affecting 441 patients. The settlement is notable for being the first that involves a data breach affecting fewer than 500 individuals. The settlement appears a signal that OCS intends to enforce HIPAA-HITECH security rules against covered entities regardless of the size of the breach. As the healthcare industry transitions to entirely electronic recordkeeping, it is a high priority for HHS to ensure that covered entities of all sizes implement adequate protections for electronic protected health information (ePHI).
The federal False Claims Act (FCA) provides incentives for employees to report employers that commit fraud by submitting false claims for federal funds. A recent case involved a company that provides hospice care, which agreed to pay more than $1.86 million to the government to settle a lawsuit brought by two former employees under the whistleblower provisions of the FCA.
The Department of Health and Human Services (HHS) is taking enforcement of the Health Insurance Portability and Accountability Act (HIPAA) Security Rule very seriously. In a recent case, a Massachusetts physician eye-and-ear group practice agreed to pay $1.5 million to settle alleged violations of the Security Rule based on an incident where a personal laptop was stolen.
The federal False Claims Act (FCA) penalizes people and organizations that submit false claims for payment to the government. The Act also provides incentives to whistleblowers who report the false claims. In 2012, fines and settlements in federal FCA cases and in cases involving similar state laws totaled more than $9 billion, a record-breaking amount, which was more than twice last year’s recoveries of $4 billion. Out of the 30 largest recoveries this year, 28 involved whistleblowers.