Medicare Compliance & Reimbursement

Compliance blunders just got more expensive.

ICYMI: HHS, CMS, OIG and other health care agencies have dramatically increased civil monetary penalties for violating several major health care laws, including the Stark Law, the Anti-Kickback Statute, the Emergency Medical Treatment and Labor Act (EMTALA) and the Health Insurance Portability and Accountability Act (HIPAA). The new CMPs appear in an interim final rule published in the Federal Register on September 6 (https://www.federalregister.gov/documents/2016/09/06/2016-18680/adjustment-of-civil-monetary-penalties-for-inflation).

The rule describes the increases as “adjustments” for inflation — in some cases, nearly 40 years of inflation, health care attorneys at Arent Fox note wryly in a recent blog post (http://bit.ly/2ddcWhe). The “adjustments” were mandated by The Bipartisan Budget Act of 2015, which also requires agencies to release annual inflation adjustments going forward, Arent Fox attorneys explain.

Here’s the maximum amount each violation of major health care laws will cost you under the new CMPs:

• Stark Law: $159,000 (up from $100,000)
• False claims submitted while Stark law is being violated: $23,863 per claim (up from $15,000 per claim)
• Anti-Kickback Statute (Civil): $73,588 (up from $50,000)
• HIPAA: $55,010 per violation with an annual cap of $1,650,300 (up from $50,000 and an annual cap of $1,500,000)
• EMTALA (patient dumping in hospitals with 100 beds or more): $103,129 (up from $50,000)