Acting US Attorney Joel Levin says the new dedicated unit aims to bring “even greater focus, efficiency, and impact to our efforts in this important area.”...more
Admissibility of statistical sampling to prove liability in FCA suit is fact dependent.
In a February 14, 2017 decision, the Fourth Circuit declined to rule on the question of whether statistical sampling can be used to...more
The report shows significant lapses in 2012 GIP service claims and recommends that CMS implement additional oversight and enforcement options....more
The DOJ’s theory of falsity based on clinical disagreement alone fails as a matter of law.
In a closely watched False Claims Act (FCA) proceeding by the healthcare industry and FCA practitioners, the US District Court...more
Follow these tips to ensure compliance in the wake of the new 60-Day Rule.
On February 12, the CMS finalized the 60-Day Overpayment Report and Refund rule (60-Day Rule) for Medicare Parts A and B. This long-awaited rule...more
The final rule relaxes the requirements on “identification” and look-back period.
The Centers for Medicare & Medicaid Services (CMS) has released its long-awaited final rule related to the reporting and refunding of...more
The court’s interpretation complicates the already difficult task providers face in having sufficient time to assess and quantify potential overpayments.
An August 3 decision in United States v. Continuum Health Partners...more
8/6/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare ,
Hospitals ,
Medicaid ,
Medicare ,
Overpayment ,
Qui Tam ,
Relators
Although CMS has not yet issued a final rule on the ACA’s 60-day repayment provisions, hospitals and other providers can still create policies and train staff in a manner that gives them some measure of protection. Even with...more
6/3/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Chief Compliance Officers ,
Compliance ,
Health Care Providers ,
Hospitals ,
Medicaid ,
Medicare ,
Medicare Part A ,
Medicare Part B ,
Overpayment
The U.S. Supreme Court ruled that a state professional board controlled by active market participants must be supervised by a state to enjoy protection from federal antitrust laws....more
3/5/2015
The OIG’s recently released study examining Medicare hospice claims from 2007 to 2012 calls for targeted reviews of hospices that receive a high proportion of their payments for care in assisted living facilities....more
CMS reconsiders $10 million bounties for reporting of regulatory violations.
On December 5, the Centers for Medicare & Medicaid Services (CMS) finalized a rule (the Final Rule) that expands its program integrity and...more
The proposed rule to give providers more protections to promote beneficiary access to care solicits significant industry input.
On October 2, the Department of Health and Human Services (HHS) Office of Inspector...more
10/6/2014
/ Affordable Care Act ,
Anti-Kickback Statute ,
Civil Monetary Penalty ,
Gainsharing ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Hospitals ,
OIG ,
Proposed Regulation ,
Safe Harbors
Hospices will be expected to be more vigilant in their decisions to cover and pay for prescription medications covered under their Medicare hospice per diem payment.
On December 6, the Centers for Medicare & Medicaid...more
Final rule aims to improve the quality and consistency of care between long-term care facilities and hospice providers but may increase conflict between facility and provider staff.
...more
OIG continues its aggressive interpretation of scope and effect of exclusion from participation in Federal health care programs and clarifies several open questions....more
Report makes no formal recommendations, but OIG notes that lengths of stay and frequency of general inpatient care are issues requiring further scrutiny....more
Proposed rule would substantially increase rewards for fraud tips and enhance billing revocation authority.
On April 29, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) that...more
OIG touts substantial benefits of disclosing, provides greater detail for different types of disclosures, and captures 15 years of OIG Self-Disclosure Protocol experience....more
CMS and OIG issue similar proposed rules to modify the electronic health record exception and safe harbor.
On April 10, the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) of...more
Enforcement action sends a strong message to the healthcare industry and reaffirms the need for security risk analysis and mobile-device security policies and procedures....more