News & Analysis as of

Beneficiaries Medicare Office of the Inspector General

Sheppard Mullin Richter & Hampton LLP

Increased Scrutiny into Agents & Brokers in the Medicare Advantage Space

Most Medicare Advantage (“MA”) beneficiaries rely on agents and brokers to help them navigate the complex process of selecting a health plan that will meet their needs. In exchange, brokers and agents received certain fixed...more

Sheppard Mullin Richter & Hampton LLP

District Court Elucidates the Meaning of “to Induce” Under the Federal Health Care Program Anti-Kickback Statute

The United States District Court for the Eastern District of Virginia recently dismissed an appeal by the Pharmaceutical Coalition for Patient Access (“PCPA”) that challenged a negative opinion issued by the U.S. Department...more

Mintz

EnforceMintz — Government Scrutiny of Medicare Advantage Organizations Expected to Continue in 2024

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Medicare Advantage (also known as Medicare Part C) remains a top enforcement priority as evidenced by False Claims Act (FCA) investigations and litigation involving nearly all large Medicare Advantage Organizations (MAOs). As...more

Sheppard Mullin Richter & Hampton LLP

OIG Permits Medical Device Manufacturer’s Cost-Sharing Subsidies for Medicare Beneficiaries in Clinical Trial

Last month, in the last advisory opinion issued by the Office of Inspector General (“OIG”) in 2023 – Advisory Opinion No. 23-11 (the “Opinion”) – OIG “blessed” an arrangement involving a medical device manufacturer (the...more

King & Spalding

OIG Recommends CMS Use OIG Hospital Compliance Audits to Enhance its Medicare Oversight

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On October 26, 2022, OIG published a report summarizing the results of 12 OIG hospital compliance audits covering Medicare claims paid from 2016 through 2018. OIG recommends, among other things, that CMS follow up on...more

Harris Beach PLLC

Inspector General Issues Report on Telehealth Services During Pandemic

Harris Beach PLLC on

Recently, the Office of Inspector General (“OIG”) for the Department of Health and Human Services published its Report on Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks...more

ArentFox Schiff

OIG Reports Indicate the Government's Interest in Balancing Ongoing Telehealth Access With Increased Oversight

ArentFox Schiff on

A pair of reports recently issued by the US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) highlight the important role telehealth services have played in ensuring access to medical...more

King & Spalding

OIG Updates COVID-19 Administrative Enforcement FAQs With Question Regarding Ambulance Providers’ Waiver or Discount of Certain...

King & Spalding on

On May 5, 2021, OIG issued guidance on its COVID-19 Administrative Enforcement FAQs page stating that an ambulance provider or supplier waiving or discounting Medicare beneficiary cost-sharing obligations presents a low risk...more

Mintz - Health Care Viewpoints

OIG Publishes Study on Claim and Payment Denials by Medicare Advantage Organizations

The HHS Office of the Inspector General (“OIG”) has reported the results of a study assessing service and payment denials by Medicare Advantage Organizations (“MAOs”). The study revealed “widespread and persistent MAO...more

Holland & Knight LLP

Healthcare Law Update: May 2018

Holland & Knight LLP on

Enforcement - OIG Issues Advisory Opinion on Provision of Samples by a Device Distributor - On April 30, 2018, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a...more

McGuireWoods LLP

OIG Raises ‘Nominal Value’ for Gifts to Medicare and Medicaid Beneficiaries

McGuireWoods LLP on

On Dec. 7, 2016, just in time for the holiday season, the Office of Inspector General (OIG) released a policy statement regarding the nominal value of gifts that healthcare providers may give to Medicare and Medicaid...more

Buchalter

OIG Finalizes New and Expanded Anti-Kickback Safe Harbors, Issues Guidance Regarding Nominal Gifts

Buchalter on

In an uncertain health care environment following the presidential election, the Department of Health & Human Services Office of Inspector General (“OIG”) finalized a new rule expanding existing safe harbors to the federal...more

King & Spalding

OIG Recommends Reevaluation of Medicare Payment System for Skilled Nursing Facilities

King & Spalding on

The HHS Office of Inspector General (OIG) released a report on September 30, 2015 finding that Medicare payments for therapy services provided at skilled nursing facilities (SNFs) greatly exceeded the cost of such services. ...more

McDermott Will & Emery

OIG Calls for CMS to Reform Payment for Skilled Nursing Facility Services

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The Office of Inspector General of the U.S. Department of Health and Human Services (OIG) issued a report on September 30, 2015, that calls for the Centers for Medicare and Medicaid Services (CMS) to reform payment for...more

King & Spalding

OIG Recommends Improvements to Skilled Nursing Facility Billing Policies Regarding Changes in Therapy

King & Spalding on

The Department of Health and Human Services Office of Inspector General (OIG) recently issued a report that calls for CMS to accelerate its efforts to implement a new method for paying for changes in skilled nursing facility...more

King & Spalding

OIG Reports Limited Compliance with Face-to-Face Certification Requirement for Home Health

King & Spalding on

The OIG recently released a report summarizing the details of its study regarding compliance with the requirement that physicians (or certain practitioners working with them) who certify beneficiaries as eligible for Medicare...more

King & Spalding

OIG Recommends that CMS Recoup More Than $100 Million in Overpayments for Incarcerated and Unlawfully Present Beneficiaries

King & Spalding on

CMS made more than $100 million in improper payments to providers for healthcare services on behalf of incarcerated and unlawfully present individuals between 2009 and 2011, according to a pair of reports issued on January...more

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