INSIDE COMPLIANCE – Page 87 – Loyola University Chicago School of Law

Climate Change: A Compliance Crisis

November 2, 2018Uncategorized

In October 2018, the Intergovernmental Panel on Climate Change of the United Nations issued a special report on the impact of global warming. The report shared extensive research about our changing atmosphere and issued a grave warning: we must act immediately. The harrowing news came just over one year after President Trump ordered the United States’ withdrawal from the Paris Climate Agreement in June 2017. This begs the question: how will changes be made when the world’s most powerful and impactful hegemon refuses to cooperate?

Climate Changeemissionsenvironmental regulationEnergyIPCCInternational AffairsJournal of Regulatory Complianceparis agreementICJUNUnited NationsUNEPRegulation

Compliance in Healthcare: Understanding Zone Program Integrity Contractor Investigations and Audits

October 31, 2018Fraud & Abuse

The Centers for Medicare and Medicaid Services (CMS) have a multitude of resources to detect and protect against fraud and abuse in claims. Particularly, CMS has at least six types of contractors that provide different roles in the prevention, detection, and reporting of fraud and abuse in healthcare. This list includes Recovery Auditors, which serve to reduce fraud and abuse by detecting and collecting overpayments from entities and Comprehensive Error Rate Testing (CERT) Contractors, which determine rates of improper payments by reviewing claims under Medicare Fee-For-Service (FFS). Another auditor that providers should be particularly mindful of are the Zone Program Integrity Contractors (ZPICs). This article is an overview ZPICS, its role in Medicare, and outlines the steps providers should take when faced with an audit by ZPICs.

Centers for Medicare and Medicaid ServicesAuditingHealthcare RegulationsHealthcare ProvidersHealthcare Professionals

Fifth Circuit Faced with Post-Marks Litigation: Do We Know What an “Automated Telephone Dialing System” is Anymore?

October 30, 2018Uncategorized

Will new litigation affect Beto O’Rourke’s campaign? With election polls opening up for early voting last week, a one week left of campaigning and the new Telephone Consumer Protection Act (the “TCPA”) litigation to defend, it is unlikely that Beto O’Rourke will be slowing down any time soon. O’Rourke has made it his mission to reach all voters, not just those residing in the three major cities: Austin, Houston and Dallas. New litigation filed October 19, 2018, raises the question whether “Beto for Texas” reached those voters in violation of the TCPA and the recent Marks v. Crunch decision. The litigation will address whether the 5th Circuit will implement Marks expansive definition of an “automated telephone dialing system.”

Beto O'RourkeBeto for TexasMarks v. CrunchFCCTCPARegulation

SCOTUS Overturns Stay, “Dark Money” Donors Will Be Partially Disclosed

October 29, 2018Finance & Banking

On September 18, 2018, the United States Supreme Court overturned a stay blocking a District Court ruling requiring non-profits to disclose identity of all contributors who give more than $200 a year. Prior to the ruling, IRS designated 501(c)(4) social welfare organizations and 501(c)(6) organizations such as business leagues and boards of trade, who do not register as political committees with the Federal Election Commission (FEC), were required to disclose donors only when they contributed for specific political advertisements. While the ruling requires the FEC to give guidance, newly issued FEC rules limit the scope of the court’s intention. It is likely that the new ruling will allow some donors to remain undisclosed while requiring partial disclosure of donors who contribute towards certain, but not all, expenditures.

electionJournal of Regulatory CompliancefinanceFECpoliticsRegulation

States Fail At Mental Health

November 12, 2018The Art of Compliance

The Mental Health Parity and Addiction Equity Act (“the Parity Act”) is a federal civil rights and consumer protection law. The Parity Act prohibits most public and private insurance plans from imposing more restrictive standards on mental health (“MH”) and substance use disorder (“SUD”) benefits than they impose on similar medical/surgical benefits. However, ten years since its passage, states have failed to appropriately enforce the Parity Act.

compliancemental healthMental Health Parity and Addiction ActJournal of Regulatory ComplianceHealthcare Regulationshealthcaresubstance abuse disorderRegulation

New York Federal Court Rules in Favor of CFTC in its First Ever Anti-Fraud Enforcement Action Involving Bitcoin

November 13, 2018Fraud & Abuse, Finance & Banking

Judge P. Kevin Castel of the U.S. District Court for the Southern District of New York entered an Order for Final Judgment and Consent Order for Final Judgment (“the Orders”) early this month, resolving charges of a Commodity Futures Trading Commission (the “CFTC”) Complaint against a New York Corporation, Gelfman Blueprint Inc. (“GBI”) and its Chief Executive Officer, Nicholas Gelfman. The CFTC’s complaint, filed in January of 2017, marked the first anti-fraud enforcement action involving Bitcoin filed by the Commodity Futures Trading Commission. The Orders found that from approximately January of 2014-January 2016 Defendants Gelfman and GBI, through its officers and agents and employees, operated a Bitcoin Ponzi scheme in which they fraudulently solicited more than $600,000 from at least 80 customers.

Journal of Regulatory Compliance

Compliance Spotlight: Cheryl Miller, JD, CHC

November 28, 2018The Art of Compliance, Compliance Spotlight

Cheryl Miller is the Director of Risk, Compliance and Legal – and Chief Compliance Officer for Presbyterian Homes, a Life Plan Community (formerly branded as a Continuing Care Retirement Community (CCRC)) in Skokie, Illinois. Ms. Miller worked as a corporate paralegal for several years before and during law school, first at a large law firm and then at Brookdale Senior Living. She moved into healthcare regulatory work, and from there learned about the Health Care Compliance Institute and went to the annual meeting. “The preciseness of Stark and Anti-Kickback and the other multitude of regulations enthralled me. I was on-site at a client (Presbyterian Homes) two days per week providing risk management services. I asked about their compliance program and gave (what I thought was) constructive criticism. A year or so later, Presbyterian Homes hired me away from the firm.” Ms. Miller was recently invited by Professor Larry Singer to speak to his Health Care Business and Finance class about the Long-Term Care industry. Her discussion enlightened many of the students and inspired enrollment in Loyola’s Long-Term Care course. The following is an interview that highlights her insight and experiences about her work in an often-overlooked area of healthcare.

Compliance Professionalscompliance officerCCRClong-term care

The SUPPORT Act of 2018: New Anti-Kickback Provisions

November 28, 2018Fraud & Abuse

On October 24, President Trump signed a new bill aimed at combatting issues arising from the opioid epidemic. This bill, entitled the Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the “SUPPORT” Act) is a combination of seventy bills that effect the healthcare industry. This act includes new and revised Medicaid and Medicare laws that relate to the opioid crisis through the expansion of substance use disorder services. However, this bill, primarily aimed to combat the opioid epidemic, contains key provisions that will affect healthcare providers. Healthcare providers should be especially mindful of this new Act, as there are new anti-kickback provisions that require compliance officers and departments to ensure that their healthcare entities are in compliance with this new law.

Anti-Kickback StatuteHealthcare RegulationshealthcareProviders

Amazon Go versus the GDPR

November 26, 2018Uncategorized

New data privacy regulations entail questioning both current and future technologies. Recently, Amazon has introduced a store concept that eliminates everyone’s least favorite things about shopping, long lines and small talk. Amazon Go is the grocery store of the future and these stores allow consumers to walk in, pick up the items that they need, and then walk right back out. That’s it. No long lines, no cashiers, no shopping carts. However, as great as this concept seems, there are still concerns from a data privacy standpoint as Amazon needs to collect personal data from its consumers in order to be able to lawfully execute these checkout-less stores.

datacompliancedata regulationamazon goamazonbig dataJournal of Regulatory ComplianceGDPRUSPrivacy & Securityprivacysams clubRegulation

City of Chicago Paid Sick Leave Ordinance Gaining Momentum

November 25, 2018Uncategorized

The City of Chicago enacted the Paid Sick Leave Ordinance to protect employees who work within the city limits. Effective July 1, 2017, the Ordinance requires employers who operate or conduct business in the City of Chicago to provide Paid Sick Leave to eligible employees. While there are some limitations about who is a “Covered Employee,” the Ordinance sets a precedent for worker’s rights. Only eight states have enacted Paid Sick Leaves Laws. Illinois is not one of those states; however the City of Chicago may be moving Illinois workers one step closer to mandatory paid sick leave.

City of Chicago; employment; paid sick leaveEmployment