Healthcare Compliance Attorneys
HHS Compliance and Regulations
The Department of Health and Human Services (“HHS”) is a cabinet-level department of the U.S. federal government that regulates the health services provided to Americans in order to protect the health and well-being of those citizens.
According to HHS, their goal is to improve the health, safety, and well-being of America.
When Was HHS Formed?
HHS used to be recognized as the Department of Health, Education, and Welfare (“HEW”).
Then, in 1979, the federal government created a separate Department of Education (“DOE”), leaving the “health” and “welfare” portion of the agency to become known as the Department of Health and Human Services (“HHS”).
What Does HHS Do?
HHS is made up of federal, state, and local health departments. These departments receive federal funding to manage health care programs. This involves implementing new health care programs when necessary.
HHS administers 115 federal health care programs. These programs consist of:
- Civil rights programs;
- Disaster relief programs;
- Social service programs;
- Healthcare privacy programs; and
- Research on health-related topics.
What Does HHS Do With Their Research Findings?
HHS partners with the Health Resources and Service Administration in order to store the research and data collected. This information must be published and made available to health care industry professionals.
HHS also provides insight and resources to allow the public to monitor national health information and educate themselves on health care related concerns like how to prevent diseases, information about health insurance companies, and contact information for healthcare providers and facilities.
What Privacy Rights Do People Have When it Comes to Healthcare?
HIPAA establishes and defines the healthcare rights of all Americans. Generally, HIPAA protects the rights of a patient to keep their medical history private and ensures that the health insurance of unemployed workers is protected.
Who Investigates Criminal Activity for HHS?
Investigations into criminal activity that affect the health and safety of the public are carried out by The Office of the Inspector General (“HHS-OIG”). This includes investigations into health care fraud.
The agents of the OIG have the same training and authority as any other federal criminal investigators. This includes the FBI, ATF, DEA and Secret Service. OIG agents also possess unique expertise when it comes to investigating white collar crimes related to Medicare and Medicaid fraud.
What Are the Primary HHS Statutes and Regulations?
Since the passage of the Fraud Enforcement and Recovery Act of 2009 and the Affordable Care Act of 2010, the HHS-OIG has taken a clear step toward addressing compliance in the health care industry through industry standards.
Recently, HHS-OIG has been particularly concerned with health care professionals who violate the provisions of the Anti-Kickback Statute and Stark Law.
What is the Anti-Kickback Statute?
The federal Anti-Kickback Statute (“AKS”), codified under 42 U.S.C. § 1320a-7b(b), makes it illegal to solicit, receive, offer, or pay or convey any kind of benefit in exchange for the referral of a patient.
Penalties for violating this statue include fines of up to $25,000, five years imprisonment, or both.
What is Stark Law?
Stark Law, codified under 42 U.S.C. § 1395nn, also known as the physician self-referral law, makes it a felony for a physician to refer a patient receiving Medicare or Medicaid benefits to any entity providing designated health services (“DHS”) if the physician–or someone in his immediate family–has a financial relationship with that entity.
According to the statute:
Penalties for violating this statute include up to $15,000 for each patient you refer or three times the amount you received as the result of the referrals if you knew or should have known that you were receiving an improper benefit.
How Can I Reduce the Risk of Violating Stark Law?
In order to completely relieve you and your practice of allegations of Stark Law violations, all contracts between physicians and hospitals should take into consideration the “9 Safe Harbors for Stark Law.”
To discover the “9 Safe Harbors for Stark Law,” click the link.
How Does HHS Regulate Medicare/Medicaid Overpayments?
The False Claims Act imposes liability on any health care provider that receives an overpayment from Medicare or Medicaid if they fail to report and return the money to the federal government.
The problem was that no one knew how long a provider had to return money to the government before they would be subject to liability.
How Long Does A Provider Have to Return Overpayments?
Increased scrutiny of cases involving the “retention of overpayments” ultimately led to the Patient Protection and Affordable Care Act (PPACA) to mandate that all overpayments distributed by Medicare and Medicaid must be reported and returned within 60 days of discovery.
Providers may also report and return the funds before the date the corresponding hospital report is due.
What is the “Public Health Service (PHS)?”
The main division of HHS is the Public Health Service (“PHS”) division. The PHS is led by the Surgeon General who is responsible for handling matters related to public health.
This division consists of a Public Health Service Commissioned Corps (“PHSCC”), which is one of the seven uniformed services of the United States.
What are the Seven Uniformed Services of the United States?
The seven uniformed services of the United States are listed below in order of superiority:
- The U.S. Army;
- The U.S. Marine Corps;
- The U.S. Navy;
- The U.S. Air Force;
- The U.S. Coast Guard;
- The U.S. Public Health Service Commissioned Corps; and
- The National Oceanic and Atmospheric Administration Commissioned Officer Corps
The Public Health Service Commissioned Corps (“PHSCC”) is one of the two uniformed services that does not consist of enlisted or warrant officer ranks, even though warrant officers have been authorized for use in within the PHSCC.
The mission of the PHSCC is to:
- Prevent and control disease;
- Identify and correct health hazards;
- Improve Americans mental health;
- Promote healthy lifestyles to Americans;
- Conduct medical, behavioral, and health research;
- Publish research and make results available to health care professionals;
- Provide health care services to medically underserved communities; and
- Work with international agencies to address global health concerns.
The PHSCC is also responsible for ensuring that:
- food is safe to consume;
- cosmetics have no harmful side effects;
- electronics do not emit dangerous levels of radiation;
- drugs and medical devices are safe and effective;
How Does HHS Prepare for Emergencies?
In order to prepare for and respond to emergencies, HHS partners with:
These agencies work hand-in-hand to ensure that “at-risk” individuals and people with special needs can receive the medical care, transportation, and supervision they need in times of crisis.
To speak to a health care fraud attorney, or for more information about HHS compliance and regulations, call The Health Law Group now >>>