Top 10 Predictions for Health Care Providers in 2016

Based on proposals in 2015 and the OIG’s Work Plan for 2016 it is likely that there will be:

Federal Regulatory Changes Affecting:

  1. The discharge planning process for hospitals, including long-term hospitals, inpatient rehabilitation facilities, critical access hospitals, and home health agencies.
  2. The implementation of Section 603 of the Bipartisan Budget Act of 2015, which concerns payment for hospital off-campus outpatient provider-based sites that are not emergency departments.
  3. The Medicare-Medicaid Conditions of Participation governing long-term care facilities.
  4. Reimbursement for therapy services provided in skilled nursing facilities.

Increased Focus on the Privacy and Security of Protected Health Information:

  1. Phase 2 HIPAA Audits of health care providers and their business associates, with increased scrutiny of policies and procedures regarding electronic protected health information.
  2. A continued increase in medical identity theft, with increased scrutiny of health care providers’ privacy and security measures to protect medical records.
  3. A proposal for further regulatory oversight of hospitals’ networked medical devices, such as dialysis machines, radiology systems, and medication dispensing systems that are integrated with electronic medical records, to protect associated electronic protected health information and to ensure patient safety.

Compliance Concerns Resulting In:

  1. Recoupment of Medicare payments for items and services furnished to alien beneficiaries who are not lawfully present in the United States.
  2. New safe harbors and the modification of existing safe harbors under the Federal Anti-Kickback Statute.
  3. RAC and/or QIO reviews of hospitals’ compliance with the 2-midnight rule and the Notice of Observation Treatment and Implication for Care Eligibility Act of 2015 (“The NOTICE Act”).


If you have questions about the Top 10 Predictions for Health Care Providers in 2016, or any concerns regarding your organization’s compliance with the items listed, please contact Rochelle H. Zapol, a partner in Prince Lobel’s Health Care Practice Group and the author of this blog. You can reach Rochelle at 617 456 8036 or


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