From Report on Medicare Compliance - Prime Healthcare Services in California allegedly covered the bases when it came to ensuring many Medicare patients would be admitted as inpatients, not placed in observation, according to the False Claims Act complaint filed by the Department of Justice (DOJ) June 23. On the front end, Prime hospitals allegedly pressured emergency department (ED) physicians to admit patients without the medical necessity for an inpatient admission, even changing Milliman Care Guidelines. Read more

From Report on Medicare Compliance - As political campaigns heat up across the country, the cool heads in compliance may want to review the laws and regulations governing political activities by corporations and employees. There are federal, state and local laws and IRS restrictions on lobbying, gifts and political advocacy, and some of the finer points may come as a surprise. “Compliance and the political law area is not necessarily intuitive,” Minneapolis attorney John Knapp said at… Read more

Compliance Blog

By Lauren Clason - June 10, 2016
The same day that a Maryland federal judge dismissed a putative class action against CareFirst, Inc. for the 1.1 million record data breach the insurer revealed last May, on the opposite coast, a California federal judge approved another one against Anthem, Inc., for the massive breach it revealed...
By Lauren Clason - April 22, 2016
While they may not fall under the HIPAA umbrella (yet), the privacy of biometric and other health data captured by the influx of new apps and wearable gadgets is a source of concern among consumers and regulators alike. The rapid evolution of health IT means it’s only a matter of time before they...
By Lauren Clason - March 15, 2016
The answer is maybe not, according to a study released on March 10 by Advisen Ltd. and sponsored by ID Experts Corp. Most cyber insurance seems to be designed as a bumper guard for major breaches, while the “vast majority” of data breaches are relatively small, falling well below the average...

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