Archive for the ‘Uncategorized’ Category

Wisconsin HIPAA Resources –

Thursday, May 21st, 2020

HIPAA Privacy:

Privacy Rule (HHS)
HIPAA Privacy Rule & Public Health (CDC)

HITECH Privacy regulation

Breach Notification for Unsecured Protected Health Information – Interim Final Rule (August 24, 2009)

HITECH Act Enforcement Interim Final Rule (October 29, 2009)

Individuals’ Right under HIPAA to Access their Health Information (February 25, 2016)

Updated Joint Guidance on Application of HIPAA and FERPA to Student Health Records (December 2019 Update) –

Other Privacy Guidance Documents

Privacy and Security Standards –
Security Rule

HIPAA Administrative Simplification Statute & Rules

NIST Security Resource

HHS Office of Civil Rights Security Rule

HHS Office of Civil Rights Security Guidance Documents and Other Important Links

State Confidentiality Law Links:

Wisconsin Stat. § 51.30 – State Alcohol, Drug Abuse, Developmental Disabilities and Mental Health Act –

Wisconsin Stat. § 146.816 – Uses and Disclosures of Protected Health Information –

Wisconsin Admin. Code ch. DHS 92 – Confidentiality of treatment records –

Wisconsin Admin. Code ch. DHS 94 – Patients Rights & Resolutions of Grievances –


Wisconsin Stat. § 49.475 – Information about Medicaid Assistance beneficiaries –
Wisconsin Admin. Code ch. DHS 108 – General Medicaid Administration –

Wisconsin Stat. § 146.81-84 – Miscellaneous Health Provisions (health care records) –
Wisconsin Stat. § 146.816 – Uses and Disclosures of Protected Health Information –
Wisconsin Stat. § 252.15 – Communicable Diseases – Restrictions on Use of HIV Tests –

Long-Term Care (Family Care)

Wisconsin Stat. ch. 46 – Long-term Care (Confidentiality – Exchange of Information) –

Wisconsin Admin. Code ch. DHS 10 – Confidentiality and Exchange of Information (Family Care)
§ DHS 10.23(7) ADRCs
§ DHS 10.45(5)


HIPAA COW (HIPAA Collaborative of Wisconsin) –
Wisconsin Office of Privacy Protection
FTC Privacy Initiatives

Wisconsin Announces Residential Renter Assistance, But Details are Scarce

Thursday, May 21st, 2020

Earlier this week, the Wisconsin Department of Administration announced the creation of the Wisconsin Rental Assistance Program. The state has allocated $25 Million to a program to assist residential renters with rent payments and security deposit obligations from the grant the state received under the CARES Act funds issued to all states. My partner, Joe Mella, posted a great article on this that you can access Wisconsin Rental Assistance

We Received a PPP Loan – Now What?

Tuesday, May 5th, 2020

By John Fisher, JD, CHC, CCEP

We Received a PPP Loan—Now What?

I wanted to direct everyone over to my law firm’s main website for excellent COVID-19 legal development coverage. Ruder Ware COVID-19 Coverage.

With a second round of Paycheck Protection Program (“PPP”) funding coming available last week, a large percentage of small businesses either have already received (or will soon receive) the proceeds of a PPP loan. At only one percent interest over two years, PPP loans present a great opportunity, but, obviously, businesses are most interested in the forgiveness component. Maximizing loan forgiveness is key.

Three of my law partners, Mary Ellen Schill, Amy E. Ebeling and Associate Benjamin E. Streckert have published a great article on what to do one you receive your Paycheck Protection Program check. Check out this article and our other great coverage of COVID-19 legal issues – Ruder Ware COVID-19 Coverage

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CMS State Goals in the COVID-19 Pandemic

Thursday, April 30th, 2020

By John Fisher, JD, CHC, CCEP

CMS has identified its general goals during the COVID-19 pandemic on a few occasions. The most recent was in the April 30, 2020 press release in which CMS introduces new regulatory waivers to assist providers as they emerge from the pandemic. CMS’ identified goals have included:

  1. To ensure that local hospitals and health systems have the capacity to handle COVID-19 patients through temporary expansion sites (also known as the CMS Hospital Without Walls initiative);
  2. To expand at-home and community-based testing to minimize transmission of COVID-19;
  3. To expand the healthcare workforce by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community or other states;
  4. To increase access to telehealth for Medicare patients so they can get care from their physicians and other clinicians while staying safely at home; and
  5. put patients over paperwork by giving providers, healthcare facilities, Medicare Advantage and Part D plans, and states temporary relief from many reporting and audit requirements so they can focus on patient care.

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Unnecessary Inpatient Admissions Results in Hospital DOJ Settlement

Wednesday, April 29th, 2020

By Fisher, JD, CHC, CCEP

Hospital Admissions Fraud Risk Area

Unnecessary Inpatient Admissions – Hospital Fraud Settlement.

An $18 million settlement was agreed by a hospital chain after allegations that claims were submitted to Medicare for patients who were admitted to an inpatient facility when they allegedly could have been treated on a less costly outpatient basis.  The government alleged that the hospital system billed Medicare for short-stay, inpatient procedures that should have been billed on a less costly outpatient basis.  The government also accused the hospital system of inflating reports to Medicare regarding the number of hours of outpatient observation care that was provided.

This is a fairly typical case where the allegation involved billing for services that were of a higher level than required by the patient.  In effect, the excess services are deemed to be medically unnecessary.  In this case, the services involved inpatient admissions that the government alleged could have been taken care of in a less costly outpatient setting.

A former employee was the whistleblower in the case and walks away with over $3.25 million from the settlement.

Read more here: Health Law Blog


The Joint Commission COVID-19 Information Page for Health Care Providers

Wednesday, April 29th, 2020

By John Fisher, JD, CHC, CCEP

The Joint Commission has issued a Coronavirus (COVID-19) guidance page for hospitals and other organizations who are accredited through that organization. The page contains a letter and a video from the CEO of the Joint Commission, Mark R. Chassin, MD, FACP, MPP, MPH.

The Joint Commission Offers Useful Resources on the COVID-19 Pandemic.

The page also contains a variety of statements from the Joint Commission, Frequently Asked Questions about the Joint Commission’s statement on use of face masks brought from home, a statement on universal masking, a public statement on the shortage of critical equipment.

The page contains an interesting section highlighting stories from health care workers who are working on the front lines of the battle against the virus.

The Joint Commission page contains topical coverage of a variety of COVID-19 issues that are being faced by health care providers. The Joint Commission offers some really good content. There are informative articles, videos, training material and a wide variety of resources related to the COVID-19 virus, organized by category.

Some of the information on the Joint Commission site includes:

  • Personal Protective Equipment (PPE)
  • Ventilator and Respiratory Support
  • Staffing andRead more here: Health Law Blog


Whistleblower Settlements Increase Compliance Risk for Providers

Thursday, April 23rd, 2020

By Fisher, JD, CHC, CCEP

Dermatology Risk Areas Fraud and Abuse

Recent Fraud Settlements Emphasize Risk of Whisttleblowers

One of the reasons why compliance officers and health care attorneys read fraud settlements is to identify the issues that the government is focused on.  The cases that the government decides to pursue are very indicative of the areas of fraud enforcement that they feel are important.  These are not the only issues that should be considered, but government enforcement actions certainly tell us what types of arrangements the government considers important.

The misfortune of the defendants involved in these cases hold a potential learning experience for everyone else.  Others have an opportunity to focus on their own operations to identify whether they are at risk in any of the areas involved in these cases.

An ancillary lesson that these settlements hold is that each was initially raised by a whistleblower.  The False Claims Act gives whistleblowers a portion of the settlement in cases where the government decides to intervene.  This in effect creates a universe of potential claimants that can include almost anyone with original knowledge of the alleged practice.

Common whistleblowers include former or disgruntled employees.  It really does not matter of the employee is or was the worst employee in the world, they can

Read more here: Health Law Blog


Denial of Access to Deadbeat Patients

Thursday, April 23rd, 2020

By Fisher, JD, CHC, CCEP

Private Practice Revises Access Procedure to Provide Access Despite an Outstanding Balance

A complainant alleged that a private practice physician denied her access to her medical records, because the complainant had an outstanding balance for services the physician had provided. During OCR’s investigation, the physician confirmed that the complainant was not given access to her medical record because of the outstanding balance. OCR provided technical assistance to the physician, explaining that, in general, the Privacy Rule requires that a covered entity provide an individual access to their medical record within 30 days of a request, regardless of whether or not the individual has a balance due. Once the physician learned that he could not withhold access until payment was made, the physician provided the complainant a copy of her medical record.

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Coronavirus Checklist for Nursing Homes and Hospitals

Thursday, April 23rd, 2020

By John Fisher, JD, CHC, CCEP

Follow the links below to download from the CDC.

A coronavirus preparedness checklist for hospitals, including long-term acute care hospitals are available from the CDC.

Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings:

Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities (LTCF):

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When is a Referral Mandate for Employed Physicians Permitted under the Stark Law?

Thursday, April 23rd, 2020

By Fisher, JD, CHC, CCEP

Referral Requirements Employed Physicians

When Employed Physicians be Required to Make Referrals for Designated Health Services

The Stark Law Regulations include a provision that dictates the conditions under which an employer of a physician may mandate referrals for designated health services. Certain specific conditions must be met if an employer wishes to require its employed physicians to make referrals to the employer’s designated health services. Many institutions assume that an employer may always require an employed physician to make referrals to its ancillary services. That assumption is not correct.

The Stark regulations provides that a physician’s compensation from a bona fide employer or under a managed care contract or other contract for personal services may be conditioned on the physician’s referrals to a particular provider, practitioner, or supplier. There are a number of specific requirements that must be present to permit referral requirements including:

  1. The required referrals can only relate to the physician’s services covered by the scope of the employment or the contract.
  2. The referral requirement must be reasonably necessary to effectuate the legitimate business purposes of the compensation arrangement.
  3. The physician’s compensation must be set in advance for the term of the agreement requiring referrals.
  4. The physician’s compensation must beRead more here: Health Law Blog