Philo D. Hall, Senior Counsel in the firm’s Health Care & Life Sciences practice, in the firm’s Washington, DC, office, was quoted in “As Biden Admin. Takes Shape, Expect Closer Scrutiny on Compliance, HIPAA, Billing,” by Roy Edroso. (Read the full version – subscription required.)

Following is an excerpt:

The advent of a new presidential administration is expected to bring changes in health care compliance enforcement: You should watch for the new wave of HHS, CMS and Department of Justice (DOJ) agencies to go after big health care-related crimes. They’re also likely to scrutinize HIPAA and the big payments made to help providers over the COVID-19 hump.

In the days since his Jan. 20 inauguration, President Joe Biden has issued several executive orders pertaining to healthcare, including a COVID-19 vaccination program, and has publicized plans for health care reform, such as increased subsidies for the Affordable Care Act

Concrete progress on those fronts will largely depend on Congress and the actions of Biden’s as-yet-unappointed department heads, including HHS Secretary nominee Xavier Becerra and Attorney General nominee Merrick Garland. Once the team is in place, however, you can expect policy adjustments that will lead federal auditors, investigators and prosecutors to pay closer attention to certain health care compliance areas than the previous administration did. …

Auditing provider relief funds

You may recall that the $120 billion in provider relief funds enabled by the CARES Act and distributed in stages during the PHE came with definite terms of use (PBN 4/23/20, 10/22/20). For instance, providers faced reporting requirements and a mandate that the payments would not serve as reimbursement for business expenses or losses. …

“In a matter of months, HHS has distributed on behalf of Congress close to $175 billion to nearly every health care provider to cover COVID-related expenses and losses,” says Philo Hall, senior counsel in the health care and life sciences practice of Epstein Becker & Green firm in Washington, D.C. “Ensuring that those funds were appropriately allocated and claimed and that providers are adhering to the terms and conditions will produce several years of work for HRSA [U.S.Health Resources and Services Administration], OIG and DOJ.”

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