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Sentara Hospitals’ $2.175 Million HIPAA Settlement

Virginia-based Sentara Hospitals has agreed to a $2.175 million settlement with the Office for Civil Rights at the U.S. Department of Health and Human Services (OCR) for alleged violations of the Health Insurance Portability and Accountability Act (HIPAA) on behalf of its ten hospitals. On April 17, 2017, the OCR received a complaint alleging that an incorrect hospital bill, containing another patient's Protected Health Information (PHI), was mailed to a...

$4 Million Settlement Latest in Growing Trend of Patient Assistance Program Scrutiny

On November 20, 2019, The Assistance Fund (TAF) agreed to pay a $4 million settlement and enter a three-year integrity agreement, to resolve allegations of False Claims Act violations related to paying impermissible kickbacks to Medicare beneficiaries. This represents the third settlement involving a patient assistance fund in the past month, indicating a trend in enforcement action. TAF operated assistance programs to assist patients, including Medicare beneficiaries, with co-payment, co-insurance,...

Texas Health and Human Services Commission Receives $1.6 Million Civil Money Penalty for HIPAA Violations

Last week, the United States Department of Health and Human Services, Office for Civil Rights (OCR) imposed a $1.6 million civil money penalty against the Texas Health and Human Services Commission (HHSC), a state agency, after a 2015 breach notification report revealed a security vulnerability on the HHSC web-facing application for its Community Living Assistance and Support Services and Deaf Blind with Multiple Disabilities program. When transferring the internal application...

Two Non-Profit Patient Assistance Programs Pay $6 Million to Settle Anti-Kickback and False Claims Allegations

Two non-profit corporations organized for the purpose of establishing and administering patient assistance programs have agreed to pay $2 million and $4 million respectively to settle allegations of assisting pharmaceutical manufacturers to pay improper kickbacks to Medicare beneficiaries. Chronic Disease Fund, Inc. (CDF) and Patient Access Network Foundation (PANF) obtained payments from manufacturers to operate patient assistance funds that assisted Medicare beneficiaries with copayments, coinsurance, and deductibles for prescription drugs....

Provider ALERT: 2020 Medicare Physician Fee Schedule Includes Expansion of Revocation Authority

Upon the annual announcement of the Medicare Physician Fee Schedule, providers are typically focused on the new payment rates and policies, but the 2020 version includes an expansion of revocation authority about which all enrolled providers must be aware. The Centers for Medicare & Medicaid Services (CMS) has always retained the discretion to deny or revoke a provider's enrollment status and corresponding billing privileges for violations of CMS rules, but...