OIG Solicits Proposals for New or Modified Safe Harbor Provisions and Additional Special Fraud Alerts

As required by Section 205 of the Health Insurance Portability and Accountability Act of 1996, the OIG has published its annual request for proposals to modify existing safe harbors to the anti-kickback statute and to develop new safe harbors and Special Fraud Alerts.  Comments are due no later than 5 p.m. on February 22, 2016.  OIG’s request states that, if possible, any responses to the request should include a “detailed explanation of justifications for, or empirical data supporting, a suggestion for a safe harbor or Special Fraud Alert.”  Additionally, the OIG request lists some of the factors it will consider when reviewing proposals, including the extent to which the proposals would affect an increase or decrease in competition among health care providers and the cost to Federal health care programs. 

CMS Announces Prior Authorization Process for Certain DMEPOS Items

On December 29, 2015, CMS released a final rule announcing it will establish a prior authorization process for certain DMEPOS items that are frequently subject to unnecessary utilization.  Though the prior authorization process will require the same information to support Medicare payment, it creates a new requirement that claims for certain DMEPOS items must have an associated provisional affirmed prior authorization decision as a condition of payment. Additionally, the rule adds the review contractor’s decision regarding prior authorization to the list of actions that are not initial determinations and thus not appealable.

Save The Date: 25th Annual Health Law & Policy Forum

King and Spalding’s annual Health Law and Policy Forum will take place on in Atlanta on March 21, 2016 with keynote speaker Bob Woodward.  To pre-register, click here.