On October 9, 2019, the U.S. Department of Health and Human Services (“HHS”) released newly proposed modifications to the safe harbor provisions for the Federal Anti-Kickback Statute. Among other proposals, HHS is proposing three substantive changes to the personal services safe harbor. Section 1128B(b) of the Social Security Act (commonly referred to as the “Anti-Kickback …
Healthcare Provider Fined for Disclosing PHI in Response to a Yelp! Review
When healthcare providers are subject to a bad review on Yelp! or similar customer-review websites and apps, it can be difficult to hold back and not provide a response or at least attempt to clarify the situation. However, healthcare providers, including dental providers, must ensure that employees who handle their social media, including customer-review websites …
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High Deductible Health Plans Allowed to Provide Additional Preventive Care Benefits for Individuals with Chronic Conditions
A high deductible health plan (“HDHP”) is not permitted to pay for medical expenses until the plan’s deductible has been satisfied, with the exception of medical expenses incurred for preventive care. Preventive care did not generally include expenses for any service or benefit intended to treat an existing illness, injury or condition. In a welcome …
Why you need to integrate behavioral health into your primary care practice
Russell Kolsrud and Gregory Moore recently authored the article, “Why you need to integrate behavioral health into your primary care practice,” for Physicians Practice. The article discusses the continuous debate regarding various health insurance reform addressed in the ACA and the effects it has had on the behavioral health industry. Kolsrud and Moore also discuss …
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The Importance of Putting Patient Care Above Profits
Erica A. Erman recently authored the article, “The importance of putting patient care above profits,” for Physicians Practice. The article discusses the case Wit v. United Behavioral Health and highlights eight principles that the court found to be generally accepted standards of care among behavioral professionals. “The importance of accessible quality behavioral health services is …
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Still Not Being Paid? Here Is Why and What Can Be Done! Eight New CPT Codes for Applied Behavioral Analytics Services Became Effective January 1, 2019
The American Medical Association CPT Editorial Panel released eight standardized and permanent codes for billing applied behavioral analytics (ABA) therapy services that became effective January 1, 2019. For the first time, adaptive behavior services are standardized for the purposes of billing and payment for those services by CMS and other third-party payors. This should be …
App Users Beware: Most Healthcare, Fitness Tracker, and Wellness Apps Are Not Covered by HIPAA and HHS’s New FAQs Makes That Clear
Individuals who use healthcare apps such as fitness trackers, weight loss, wellness, exercise, etc., BEWARE! A couple of recent developments have highlighted the fact that most apps are not subject to HIPAA, which means that with broadly-worded privacy policy these healthcare apps can and do readily share healthcare and other data collected by the apps …
Are Medical Marijuana Businesses Subject to HIPAA?
With medical marijuana legal in an ever-growing number of states, many businesses in the cannabis industry, particularly dispensaries, continue to wrestle with the question of whether they are subject to the Health Insurance and Portability and Accountability Act’s (HIPAA) Privacy and Security Rule requirements. The bad news is that the answer is, it depends. The …
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Understanding the HIPAA Security Rule and Tailoring Policies to Fit Your Business
Purpose and Practicality The HIPAA Security Rule[1] was designed to protect the confidentiality, integrity, and availability of a patient’s protected health information (PHI) while allowing flexibility for each covered entity based on their size, complexity, technological capabilities, cost constraints, and the likelihood of potential risks to the electronic PHI (ePHI) they house. To make the …
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Sixth Circuit Court of Appeals Rules that Retiree Health Benefits May be Terminated Based on Ordinary Contract Principles
In its latest case addressing retiree health benefits, the Sixth Circuit Court of Appeals has held that a collective bargaining agreement’s general durational clause controls when retiree healthcare benefits end. Zino v. Whirlpool Corp., 2019 BL 50961, 6th Cir. (2019). This is a new data point indicating that the Sixth Circuit has moved away from …