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Final rules that will govern the state-based insurance exchanges created by health reform include more detailed privacy and security requirements for the exchanges themselves and participating insurers. These restrictions also will apply indirectly to agents, brokers and others involved in this process. In the rules, published March 27 (77 Fed. Reg. 18310), the U.S. Department […]
FMLA certification can be tricky to administer. On one hand, it’s a fairly straightforward way to ensure that the employee is truly eligible to take FMLA leave. On the other hand, what are you to do when the employee repeatedly forgets to give you the certification form from his doctor, or fails to return it […]
A health insurer agreed to pay $1.5 million and adopt a detailed corrective action plan to resolve HIPAA security allegations stemming from a 2009 data breach. This is the first HIPAA enforcement action to result from the breach reports now required by the HITECH Act. Like many data breaches that have been making the news […]
The U.S. Department of Health and Human Services (HHS) is refocusing its HIPAA privacy enforcement efforts on seeking monetary penalties in cases of “abject failure” to comply, the head of HHS’ Office for Civil Rights (OCR) indicated. “The majority of matters we handle are going to be resolved through education” as they have in the […]
Citing concerns from health care providers, federal regulators are delaying the compliance deadline for HIPAA’s ICD-10 code set rules, which had been scheduled for Oct. 1, 2013, the agency announced Feb. 16. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead,” said […]
A 39-month prison sentence was handed down Feb. 1 for an Alabama woman who had pleaded guilty to stealing more than 4,000 patient records from a Birmingham hospital. A federal district court sentenced Chelsea Catherine Stewart to 15 months for wrongfully obtaining individual health information in violation of HIPAA, along with an unrelated bank fraud attempt […]
A mandatory uniform standard for health plans to pay claims electronically was adopted in rules issued Jan. 5 by the U.S. Department of Health and Human Services (HHS). The rules are designed to help health care providers match payments received with the “remittance advice” transactions that plans are already sending them under an existing HHS […]
The feds’ decision to release Medicare claims data for quality measurement should help employers and individuals alike make more informed decisions down the road, advancing the goals of health care quality and value, a plan sponsor representative noted. Importantly, the Centers for Medicare and Medicaid Services’ (CMS) final rules apparently will allow the selected data […]
The effect of the Mental Health Parity and Addiction Equity Act (MHPAEA) on prior authorization practices and other “nonquantitative treatment limitations” was clarified Nov. 17 in guidance from the U.S. Department of Labor (DOL). The MHPAEA interim final rules issued in February 2010 imposed a detailed numerical formula for determining whether quantitative limits such as copayments […]
A wave of HIPAA privacy audits far more comprehensive than anything attempted to date was officially launched Nov. 8 by the U.S. Department of Health and Human Services (HHS). While their official purpose is not enforcement, these audits are likely to cast a broader net than HHS scrutiny has to date — including possibly group […]