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Compliance Update
Government's Antitrust Activity Sends Confusing Signals to Healthcare Entities Print E-mail
Written by FHI's Week in Review   
Tuesday, 29 December 2015 17:33

Two back to back reports from detail antitrust activities in PA and IL:

The Federal Trade Commission
and Pennsylvania Attorney General have challenged the proposed combination of The Penn State Hershey Medical Center and PinnacleHealth System in Harrisburg, Pennsylvania, alleging that the combination would create a dominant provider, reduce the number of competing health systems in the area from three to two, and result in a 64 percent share of the market for general acute care inpatient hospital services.
Meanwhile, in a 12.23.15 post entitled FTC Challenges Chicago-Area Health System Combination
The Federal Trade Commission (FTC) has issued an administrative complaint challenging the proposed combination of Advocate Health Care Network (Advocate) and NorthShore University Health System (NorthShore) in the Chicago area as a violation of both FTC Act Section 5 and Clayton Act Section 7. The FTC, joined by the Illinois Attorney General, also filed a complaint in federal district court in Chicago seeking a temporary restraining order and preliminary injunction to prevent Advocate and NorthShore from consummating their merger pending completion of the FTC's administrative trial on the merits of the transaction.

Read more in the current issue of Week in Review

Last Updated on Sunday, 10 January 2016 16:59
EPCS: Understanding the Regulations Print E-mail
Written by Seth Flam, DO   
Thursday, 10 December 2015 00:00

On June 1, 2010 the government enacted the Electronic Prescriptions for Controlled Substances law. The purpose of the EPCS law was to revise DEA regulations to provide practitioners with the option of transmitting prescriptions for controlled substances electronically. In fact, you may have received a letter from the DEA in 2010 that said a law was passed that allowed for EPCS. Legally, there was a path to EPCS but the law was just the first baby step toward that goal. The letter that most providers received was misleading, though, because it presented the notion that EPCS was an immediate possibility - but that was just not true. The passage of the law made EPCS theoretically possible, but at that time the ecosystem was not even close to being ready. It has taken a full five years for the EPCS ecosystem to mature.

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With the New Year Comes Greater HIPAA Oversight Print E-mail
Written by The Health Law Offices of Anthony C. Vitale   
Wednesday, 09 December 2015 09:33

HIPAA-regulated entities can expect 2016 to be the year of increased oversight. That's when the Health and Human Services Department's Office for Civil Rights (OCR) begins Phase II of its audit program.

The program is expected to focus on common areas of noncompliance and will include HIPAA-covered entities as well as business associates. Phase 2 "will test the efficacy of the combination of desk reviews of policies as well as on-site reviews."

OCR is responsible for overseeing covered entities' compliance with the Privacy Rule, which provides federal safeguards to maintain the privacy of individuals' protected health information. To that end, OCR has indicated that it will select 350 covered entities and 50 business associates during the next three years to conduct audits.

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Last Updated on Saturday, 26 December 2015 11:55
OIG's 2016 Work Plan: Mixed Results for 2015 and New Data Mining and Policy Efforts in 2016 Print E-mail
Written by   
Thursday, 26 November 2015 00:00

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) annual release of a new Work Plan both summarizes the results achieved last year and highlights new areas for examination in the next. This year's Work Plan reported rising audit results but declining investigative results, in contrast to previous years.

In examining the new topics added to the Work Plan, two themes emerge. First, many of the new payment audits reflect OIG's use of data mining to identify providers or suppliers who could potentially be considered "outliers" from the average use of a particular code or procedure. Data mining will also play a significant role in connection with the second theme-a notable increase in OIG's review of significant, and some controversial, policy issues concerning changes in the country's health care delivery system, operation of HHS programs and the effectiveness of HHS agency oversight of those changes and programs.

Based on how OIG identified new study topics, the main takeaway from the Work Plan is "know your data." Whether the issue is Medicare claims or data reporting obligations, the OIG increasingly turns to data analytics to both generate audit or investigative leads or to study HHS program effectiveness.

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Last Updated on Friday, 27 November 2015 18:05
Doctor, patient frustration over pain med access leads to pharmacy rule change Print E-mail
Written by   
Tuesday, 24 November 2015 00:00

The Florida Board of Pharmacy recently approved a rule change designed to help patients get the pain medications they need.
The rule, which grew out of claims from frustrated patients and their physicians, is aimed at training pharmacists to change the way they look at prescribing controlled substances - from one of finding reasons to reject prescriptions, to one of making sure patients get the medications they need.
The board, in writing its rule, said "pharmacists should not fear disciplinary action from the board, or other state regulatory or enforcement agencies, for dispensing controlled substances for a legitimate medical purpose in the usual course of professional practice."

However, pharmacists still must take proper steps to determine that the prescription was issued for a legitimate medical purpose. One way would be to access the Prescription Drug Monitoring Program's database.
If a pharmacist believes that a prescriber is involved in the diversion of controlled substances, he or she has the obligation to report the prescriber to the Florida Department of Health.

The rule change comes in response to growing complaints from patients, doctors and pharmacists after a federal crackdown on so-called "pill mills"...
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Last Updated on Wednesday, 25 November 2015 17:48
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