In a September 2022 brief concerning program integrity, the Health and Human Services Office of Inspector General (OIG) identified seven measures to identify providers who may present a high risk for improper Medicare...more
The Affordable Care Act requires any person who has received an overpayment from certain defined government health programs to report and return the overpayment within 60 days after the overpayment is identified. If an...more
A recent Office of Inspector General (OIG) advisory opinion approved a proposal under which a hospital has established a caregiver center that provides or arranges for free or reduced-cost support services to caregivers in...more
8/30/2018
/ Alternative Fee Arrangements ,
Anti-Kickback Statute ,
Caregivers ,
Civil Monetary Penalty ,
Free Health-Related Services ,
Health Care Providers ,
Inducements ,
Low-Income Issues ,
Medicaid ,
Medicare ,
OIG ,
Remuneration
One of the reasons compliance officers and health care attorneys read fraud settlements is to identify issues the government is focused on. The cases the government decides to pursue are very indicative of the areas of fraud...more
5/18/2018
/ Anti-Kickback Statute ,
Controlled Substances Act ,
DEA ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Medicare ,
Opioid ,
Patient Referrals ,
Pharmaceutical Industry ,
Prescription Drugs ,
Stark Law ,
Whistleblowers
A relatively recent case involving buy-in terms in an ambulatory surgery center demonstrates how different valuations for referral sources and non-referral sources can be evidence of remuneration under the Medicare...more
Medical practices that routinely use laser technology are subject to some of the same legal issues as other types of practices. Use of lasers creates additional compliance issues and highlights certain compliance risk areas....more
4/10/2017
/ 60-Day Rule ,
Compliance ,
False Claims Act (FCA) ,
Fraud ,
Fraud and Abuse ,
Healthcare Fraud ,
HIPAA Audits ,
Medicare ,
Physicians ,
Risk Assessment ,
Risk Mitigation ,
Telehealth
Three relatively recent cases involving dermatology billing practices illustrate some of the main compliance risks faced by dermatology practices...more
In 2013, the HHS Office of Inspector General issued revised protocols outlining the process through which health care providers are able to self-disclose and resolve potential liability under the OIG’s civil monetary penalty...more
3/21/2017
/ Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
Exclusion List ,
Federal Health Care Programs (FHCP) ,
Health Care Providers ,
Medicaid ,
Medicare ,
Medicare Billing Privileges ,
OIG ,
Provider Self-Disclosure Protocol ,
Settlement
Medicare permits a physician to bill for certain services furnished by a nurse practitioner or other auxiliary personnel under what is referred to as the "incident to" billing rules. The "incident to" rules permit services...more
Recent OIG Release Emphasizes Need for Compliance Policies Specific to Provider Risks The Office of Inspector General recently published results of its audit of Medicare claims for chiropractic services made by a chiropractic...more
The Center for Medicare and Medicaid Services has issued a final rule that revises and modernizes the Conditions of Participation (COP) for Home Health Agencies. The Final Rule can be found in its entirety at: Final Home...more
The HHS Office of Inspector General recently released a report indicating deficiencies in hospice election statements and physician certification of patient eligibility for hospice care. Medicare hospice care provides help...more
In June, I published a blog article on a decision of the United States Supreme Court that appeared to change the law applicable to “false certification” in the 7th Judicial Circuit Circuit. The Supreme Court decision in...more
When Congress originally passed the False Claims Act (31 USC §§ 3729-3733), no one had the health care system in mind. The False Claims Act was also commonly referred to as the “Lincoln Law”. The original law was focused on...more
On October 4, 2016, the Center for Medicare and Medicaid Services (CMS) published a final rule to revise the requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. CMS...more
11/3/2016
/ Binding Arbitration ,
Centers for Medicare & Medicaid Services (CMS) ,
Elder Abuse ,
Long Term Care Facilities ,
Medicaid ,
Medicare ,
Nursing Homes ,
Physicians ,
Prescription Drugs ,
Quality of Care Standards ,
Training Requirements ,
Video Recordings