Monday, January 28, 2013

HHS Issues Final HIPAA/HITECH Rule


The United States Department of Health and Human Services (“HHS”) issued its Final Rule modifying the requirements of the Health Insurance Portability and Accountability Act (“HIPAA”) privacy and security regulations pursuant to the Health Information Technology for Economic and Clinical Health Act (“HITECH”) on January 17, 2013. The Final Rule strengthens the privacy and security requirement of HIPAA governing protected health information (“PHI”) and gives HHS greater enforcement authority to police violations of the privacy and security requirements. The Final Rule will require health care providers and their business associates to re-evaluate their HIPAA compliance policies and procedures to avoid potential liability for violations of HIPAA requirements.

Thursday, January 24, 2013

After A Two-And-A-Half Year Wait, HHS Finalizes
Modifications to HIPAA Rules: Prepare Now For Changes


On January 17, 2013, the U.S. Department of Health and Human Services ("HHS") issued the highly anticipated omnibus final rule (the "Final Rule") to modify the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") pursuant to the Health Information Technology for Economic and Clinical Health Act ("HITECH"). Following the enactment of HITECH, HHS issued interim final rules to implement the breach notification requirements and certain of the enforcement provisions of HITECH (collectively, the "Interim Rules"), and in July of 2010 HHS issued a proposed rule to implement modifications to the privacy and security provisions of HIPAA. Since that time, Covered Entities and their Business Associates and subcontractors have been awaiting the Final Rule to confirm the extent to which these modifications, which are aimed primarily at strengthening the privacy and security protections for protected health information ("PHI") and tightening the HIPAA enforcement provisions, will impact their operations, contractual relationships and potential exposure for HIPAA liability.

The Wrap-Around Slap-Around for
Primary Care Centers


For Kentucky Primary Care Centers (“PCCs”), Rural Health Centers (“RHCs”), and Federally Qualified Health Centers (“FQHCs”), getting the run-around from Medicaid on wrap-around payments is not so unusual.  Frequently, these providers complain that supplemental payments distributed by the Kentucky Department for Medicaid Services (“Medicaid”) are too low, too late or both.

Last week, the situation got worse for PCCs who received a slap in the face from Medicaid in the form of a letter declaring that, effective February 1, 2013, PCCs that do not carry a federal designation as a rural health care provider will no longer receive Medicaid wrap-around payments.

Thursday, January 10, 2013

United States Dismisses False Claims Act Lawsuit
Against Renal Care Group After Seven Years of Litigation


In late December 2012, the United States filed a stipulation of dismissal in United States ex rel. Williams v. Renal Care Group, et al., No. 3:09-cv-00738 (M.D. Tenn.), bringing to close the seven-year-old False Claims Act lawsuit filed against Renal Care Group, Renal Care Group Supply Company, and Fresenius Medical Care Holdings, Inc.

The United States' stipulation of dismissal followed the October 2012 decision by the United States Court of Appeals for the Sixth Circuit (opinion available here), which reversed the district court’s grant of summary judgment in favor of the United States, vacated the $82 million award in damages and penalties levied against the defendants, and entered summary judgment in favor of the defendants on two of the six counts brought by the United States. The district court’s entry of the United States' stipulation of dismissal resulted in the dismissal of the remaining four counts brought against the defendants by the United States.

Tuesday, January 8, 2013

Play or Pay Mandate: IRS Issues Proposed
Regulations on the Affordable Care Act


On December 28, the Internal Revenue Service issued proposed regulations (now available here) providing much-anticipated guidance with respect to the requirement under the Patient Protection and Affordable Care Act of 2010, as amended (the "Affordable Care Act") that large employers offer health plan coverage to certain employees. This employer shared responsibility requirement is often referred to as the "play or pay mandate."

Starting in 2014, under the play or pay mandate, employers with at least 50 full-time equivalent employees must offer an eligible health plan that provides minimum value on an affordable basis to employees and their dependents. An employer that fails to provide the requisite coverage will risk being assessed a penalty if any of its full-time employees (i.e., in general, employees working an average of 30 hours per week) receive subsidized coverage through a health plan exchange. If an employer fails to offer an eligible health plan and at least one full-time employee receives subsidized coverage through a health plan exchange, the annual penalty is $2,000 per full-time employee (less 30 employees). If an employer offers an eligible health plan, but at least one full-time employee receives subsidized coverage through a health plan exchange because the employer’s plan does not provide minimum value or is not affordable, the annual penalty is the lesser of (i) $2,000 per full-time employee (less 30 employees) or (ii) $3,000 per full-time employee receiving subsidized coverage through a health plan exchange.