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Office of the Inspector General Fee-for-Service

Foley & Lardner LLP

“Let’s Talk Compliance”: Medicare Advantage: Compliance Issues and Enforcement

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Editor’s Note: PYA and Foley & Lardner hosted the 6th Annual “Let’s Talk Compliance” two-day Virtual Conference on January 18 and 19, 2024. Panelists included Foley & Lardner attorneys and PYA experts. The event was hosted by...more

Harris Beach PLLC

Updated Medicaid Utilization Review Regulations from NYS Department of Health

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The New York Department of Health (DOH) adopted regulations effective on September 13, 2023, that revised Medicaid Utilization Review for Medicaid fee-for-service benefits. The regulations were initially published on April...more

McDermott Will & Emery

HHS OIG Develops Toolkit to Analyze Telehealth Claims to Assess Program Integrity Risks

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On April 20, 2023, the United States Department of Health and Human Services Office of the Inspector General (HHS OIG) released a new toolkit designed to help analyze telehealth claims to assess federal healthcare program...more

Ruder Ware

OIG Identifies Seven Telehealth Fraud Indicators in Recent Program Integrity Brief

Ruder Ware on

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

Ballard Spahr LLP

CMS Postponement of Medicare Advantage RADV Audit Rule Keeps Stakeholders Guessing

Ballard Spahr LLP on

Summary - On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) published notice that it will postpone for another three months the finalization of a methodology to audit Medicare Advantage (MA)...more

Harris Beach PLLC

Inspector General Issues Report on Telehealth Services During Pandemic

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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 Publishes Report on Program Integrity Risks Related to Medicare Telehealth Services During the First Year of the Pandemic

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On September 2, 2022, OIG published a report of its findings summarizing its investigation into whether providers appropriately billed for Medicare beneficiaries’ telehealth services. This report analyzed data from the...more

Sheppard Mullin Richter & Hampton LLP

Analysis of OIG’s New and Revised Regulatory Safe Harbors to the Federal Health Care Program Anti-Kickback Statute and Beneficiary...

In our November 25, 2000 Healthcare Law Blog article, “Big Changes for Health Care Fraud and Abuse: HHS Gifts Providers Updates to the Stark Law and the AKS, Just in Time for the Holidays,” we discussed the advanced...more

Hogan Lovells

HHS Regulatory Sprint takes final shape, Part 2: AKS, Stark regulatory revisions for value-based care

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Following on last October’s publication of two proposed rules, the Department of Health and Human Services (HHS) published on November 20 two final rules intended to “modernize and clarify” the physician self-referral (Stark)...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 42. News Briefs: November 2020 #2

Report on Medicare Compliance 29, no. 42 (November 23, 2020) - CMS said Nov. 16 that the Medicare fee-for-service improper payment rate dropped to 6.27% in FY 2020 from 7.25% last year, although CMS had to “modify”...more

King & Spalding

HHS Issues Final Rules Implementing Stark Law and Anti-Kickback Statute Reforms

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On Friday of last week, HHS published two long-awaited final rules implementing significant changes to the regulations under the Stark Law and Anti-Kickback Statute (AKS). The two final rules are: (i) Revisions to the Safe...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 21. News Briefs: June 2020 #2

Report on Medicare Compliance 29, no. 21 (June 8, 2020) - The HHS Office of Inspector General (OIG) has released its Semiannual Report to Congress, which covers Oct. 1, 2019, through March 31, 2020. During this period, OIG...more

Health Care Compliance Association (HCCA)

Compliance Perspectives: Changes to the Physician Self-Referral and Anti-Kickback Rules

As healthcare moves increasingly from fee-for-service model to one focused on outcomes and value-based payments, the traditional fraud and abuse laws, such as the Anti-Kickback Statute and the Stark Law, pose obstacles to...more

Ward and Smith, P.A.

CARES Act Provider Relief Fund – Acceptance of Funds Comes with Conditions

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Healthcare providers are among those financially adversely affected by the COVID-19 pandemic. A survey conducted by the Medical Group Managers Association ("MGMA") on April 7 and 8, 2020, found that 97% of medical...more

Polsinelli

Assessing the Stark and Anti-Kickback Proposals for Value-Based Arrangements

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Through two separate notices of proposed rule-making (NPRMs), the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG), seek to remove...more

Miles & Stockbridge P.C.

HHS Publishes Proposed Stark and AKS Updates

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On October 9, 2019, the Department of Health and Human Services' Centers for Medicare and Medicaid ("CMS") and Office of Inspector General ("OIG"), respectively, published proposed rules updating the long-standing physician...more

WilmerHale

Proposed Changes to Stark and Anti-Kickback Regulations May Provide New Flexibility for Healthcare Providers

WilmerHale on

On October 9, 2019, the Department of Health and Human Services (HHS) announced proposals for a number of new and revised exceptions to the Stark Law and safe harbors for the Anti-Kickback Statute (AKS) that are intended to...more

Sheppard Mullin Richter & Hampton LLP

Blog Series Part 3: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug...

Medicare Advantage and Part D Preclusion List - The proposed rule issued November 1, 2018 (the “Proposed Rule”) by the Centers for Medicare and Medicaid Services (“CMS”) includes a number of regulatory changes to the...more

Baker Donelson

OIG February 2018 Work Plan Update

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The OIG added three items to its Work Plan with the February 2018 update, as listed in the chart below. Two of the items concern annual reports, one addressing the performance of Medicaid Fraud Control Units and the other...more

Foley & Lardner LLP

Top Three Reasons ACOs Should Use Telehealth and Telemedicine

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Accountable Care Organizations (ACOs) can share costs of telehealth and remote patient monitoring services among their hospitals, providers/suppliers, and other ACO participants, according to federal regulations under the...more

Polsinelli

Coming Soon to a Hospital near You: Mandatory Bundled Payments for Common Surgeries

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Recent action by the Centers for Medicare and Medicaid Services (CMS) announces significant change in reimbursement methodology for high volume orthopedic surgical procedures in many markets nationwide. Affected stakeholders...more

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