On March 11, the U.S. Department of Justice and U.S. Attorney’s Office announced that Aetna, a national health insurer, has agreed to pay $117,700,000 to settle alleged violations of the False Claims Act (FCA). The government was investigating Aetna for submitting inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan beneficiaries, which increased Aetna’s
OIG Issues Favorable Advisory Opinion for Waiving Cost Sharing for Cancer Screening Test
In a recent Advisory Opinion (No. 26-01), the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) concluded that waiving cost sharing for certain commercially insured patients who receive a cancer screening test is permissible under the federal Anti-Kickback Statute.
The opinion pertains to a clinical laboratory test that screens for
OCR Issues Guidance on Parental Access to Children’s Medical Records
It was brought to the attention of the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) that healthcare providers may be violating HIPAA in certain instances where they deny parental access to a child’s medical records, or require the child to authorize the disclosure of their medical records to the parent
Dental Practice Settles Data Breach Lawsuit for $1.2 Million
Ransomware cyber attacks have been a prominent threat to the healthcare industry. In this case, First Choice Dental, a large dental practice with multiple locations across Wisconsin, was targeted by hackers in October 2023. The hackers gained access to sensitive information including patient names, dates of birth, Social Security numbers, passport numbers, driver’s license numbers
Nursing Home Company Pays HIPAA Fine for Publicizing Patient Success Stories
A company that runs five nursing homes in Delaware recently agreed to pay a $182,000 fine to settle an investigation for alleged HIPAA violations. The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) investigated the company, referred to collectively as the Cadia Healthcare Facilities, after it received a complaint that the
OIG Issues Favorable Advisory Opinion on Donations to Non-Profit Foundation
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) has issued a favorable Advisory Opinion for a non-profit foundation receiving donations from an affiliated company. The company in this case offers family-based therapy for children with a redacted “Disorder” (presumably autism), where the goal of the therapy sessions is to train
OCR Announces $800,000 HIPAA Settlement with Florida Health System
The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) has announced another settlement for alleged violations of HIPAA. OCR investigated BayCare Health System, which serves central Florida, after a patient complained to OCR in 2018 that her medical record was accessed by an unauthorized individual.
The patient told OCR that she
Hospital CEO Jailed for Conspiracy to Violate AKS
The U.S. Department of Justice announced on January 15 that Jeffrey Paul Madison, the former chief executive officer of a Texas hospital, was sentenced to 36 months in federal prison for conspiring to violate the federal Anti-Kickback Statute (AKS). In October 2024, Madison also agreed to pay over $5.3 million to settle allegations under the
Million Dollar Penalty Imposed on Pain Management Practice Following HIPAA Breach
The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced on December 3 that it imposed a $1.19 million penalty on Gulf Coast Pain Consultants, a pain management practice in Florida, following a security breach that affected over 34,000 individuals.
Gulf Coast filed a breach notification report with OCR, as required
OCR Imposes $240,000 Penalty in HIPAA Ransomware Investigation
The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) imposed a $240,000 civil monetary penalty against Providence Medical Institute in connection with a ransomware attack that revealed vulnerabilities in the Institute’s systems and potential HIPAA violations.
The Institute was the victim of a series of ransomware attacks in 2018 that compromised