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Texas Attorney General’s Medicaid Fraud Control Unit Helps Secure 49-Month Sentence and Over $5 Million Restitution in Orthopedic Supplies Fraud Case

This is a common tale. It seems like most of my time is spent explaining to clients why you cannot pay marketers a percentage of the revenue derived from patients they refer to them. Press Release from Texas Attorney General: Griffin obtained patients by offering and paying kickbacks to marketers as well as disguising illegal […]

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HHS Office of Civil Rights Requiring Healthcare Providers to Use HIPAA-compliant Telehealth Platforms by August 10

HHS Office of Civil Rights is requiring all healthcare providers to use HIPAA-compliant telehealth platforms by Aug. 10. When the Public Health Emergency ended in May, CMS provided a transition period for covered health care providers to come into compliance with the HIPAA Rules with respect to their provision of telehealth. The transition period will […]

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Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, & Texas

CMS is placing newly enrolling hospices located in Arizona, California, Nevada, and Texas in a provisional period of enhanced oversight. Over the last 12 months, we’ve received numerous reports of hospice fraud, waste, and abuse. The number of enrolled hospices has also increased significantly in these states, raising serious concerns about market oversaturation. “New hospices” […]

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Artificial Intelligence, Cybersecurity and the Health Sector

HHS Health Sector Cybersecurity Coordination Center (HC3) has published a report (PDF) detailing cybersecurity concerns for healthcare providers. In particular, what can be done to remain secure, given AI-enhanced cyberthreats. The report provides an educational overview of regenerative IA, particularly ChatGPT and the difference between machine learning and neural networks. More importantly, the report discusses […]

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Texas Lawyer Convicted of Conspiracy and Perjury for Laundering Kickbacks

This was intentional criminal conduct of conspiracy and perjury related to Anti-Kickback Statute violations. From a U.S. Attorney’s Office for the Eastern District of Texas Press Release: “By facilitating kickbacks, this defendant knowingly enabled theft from Medicare and Medicaid, putting personal profit before legitimate patient needs and ultimately costing taxpayers millions of dollars,” said Jason […]

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OIG Advisory Opinion 23-04 – Favorable Opinion Regarding the Use of an Online Health Care Directory by Federal Health Care Program Beneficiaries

A website offers users the ability to search for physicians and other health care providers who have paid a fee to be included in the database. The website generates personalized results using a proprietary algorithim. The user can book an appointment with the provider directly through the website. No fee is charged to the user. […]

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Toolkit: Analyzing Telehealth Claims to Assess Program Integrity Risks

This toolkit provides detailed information on methods to analyze telehealth claims to identify program integrity risks associated with telehealth services. It is based on the methodology that OIG developed for the report Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks , which identified Medicare providers whose billing for telehealth services […]

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Supreme Court Preserves Access to Abortion Pill Mifepristone

The Supreme Court preserves access to the abortion pill mifepristone while the appeals play out. The case goes back to the 5th Circuit, where the FDA will pursue a full appeal of Kacsmaryk’s preliminary injunction. The agency and the anti-abortion groups will both have a chance to file briefs, and the case is scheduled to […]

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Office for Civil Rights Reminder HIPAA Flexibilities End May 2023

HHS Office of Civil Rights confirmed that that four Notifications of Enforcement Discretion (“Notifications”) will expire upon expiration of the COVID-19 PHE, which is currently scheduled for 11:59 p.m. on May 11, 2023. OCR’s notice applies to four Notifications of Enforcement Discretion of HIPAA related to the following circumstances: COVID-19 Community-Based Testing Sites during the […]

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HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care

HHS Office of Civil Rights has proposed changes to HIPAA’s Privacy Rule which would prohibit disclosures to law enforcement related to obtaining or providing abortions. The current Privacy Rule permits covered entities to disclose Protected Health Information (PHI) about an individual for law enforcement purposes “pursuant to process and as otherwise required by law”, under […]