The following is a summary of selected federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported...more
3/14/2024
/ Bribery ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
False Billing ,
False Claims Act (FCA) ,
Federal Health Care Programs (FHCP) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Medicaid ,
Medicare Fraud ,
OIG ,
Opioid ,
Risk Assessment ,
Sentencing ,
Telemarketing ,
TRICARE ,
Wire Fraud
The following is a summary of selected federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported...more
2/7/2024
/ Criminal Convictions ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Billing ,
False Claims Act (FCA) ,
False Statements ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Indictments ,
Kickbacks ,
Medicaid ,
Medicaid Drug Rebate Program ,
Medicare ,
Money Laundering ,
OIG ,
Pharmaceutical Industry ,
Physicians ,
Settlement ,
Telemedicine ,
Underpayment
The New York Department of Health (DOH) recently announced it is accepting applications for New York Health Equity Reform: Social Care Networks regional grants. The nine regional grants will distribute a total of $500 million...more
1/24/2024
/ 501(c)(3) ,
Applications ,
Equity ,
Filing Deadlines ,
FQHC ,
Governance Standards ,
Grants ,
Healthcare Reform ,
Home and Community Based Services (HCBS) ,
MCOs ,
Medicaid ,
New York ,
State Health Departments
On January 3, 2024, the New York State Office of the Medicaid Inspector General (“OMIG”) posted its 2024 Work Plan. This is the first update since its 2019 – 2020 Work Plan and OMIG notes that the Work Plan does not reflect...more
1/10/2024
/ Auditors ,
Audits ,
Compliance ,
Durable Medical Equipment ,
Home Health Care ,
Investigations ,
Long-Term Care ,
MCOs ,
Medicaid ,
Mental Health ,
New York ,
OMIG ,
Pharmacies ,
Self-Disclosure Requirements
The following is a summary of selected federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported...more
12/8/2023
/ Anti-Kickback Statute ,
Compliance ,
Criminal Convictions ,
Department of Health and Human Services (HHS) ,
False Billing ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Medicaid ,
Medicare ,
OIG ,
Pharmaceutical Industry ,
Pharmacies
The Department of Health and Human Services’ (“HHS”) Office of Inspector General (“OIG”) and the Department of Justice (“DOJ”) published their joint Report on the Health Care Fraud and Abuse Control Program for Fiscal Year...more
The New York Department of Health (DOH) is seeking public comment on its revised rulemaking that seeks to establish procedures for review and approval of applications from not-for-profit corporations to be certified as a...more
The New York State Office of the Medicaid Inspector General (“OMIG”) recently issued a listserv to clarify the August 22, 2023, publication of its Abbreviated Self-Disclosure Process. No changes were announced to the...more
This opinion addresses a proposed arrangement (“Proposed Arrangement”) between a multi-specialty physician practice (“Requestor”) that employs approximately 11 physician employees (“Physician Employees”). In addition to base...more
On September 21, 2023, the New York State Office of the Medicaid Inspector General (“OMIG”) posted on its website Compliance Program Requirements Frequently Asked Questions. OMIG intends the FAQs to supplement its Compliance...more
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
On August 21, 2023, the New York State Office of the Medicaid Inspector General (“OMIG”) updated its Medicaid Self-Disclosure Program Requirements. The updated Instructions and Guidelines announce a new “Abbreviated”...more
The Department of Health and Human Services’ Office of Inspector General (“OIG”) willmodernize its Compliance Program Guidance (“CPG”) beginning at the end of calendar year 2023. The updates will be posted on the OIG website...more
The New York State Office of the Medicaid Inspector General (“OMIG”) conducted three statewide sessions to outline its audit process as it pursues its mission to prevent and detect fraud, waste and abuse in the Medicaid...more
The New York State Office of the Medicaid Inspector General (“OMIG”) announced March 30 it will host provider engagement forums in Albany, Rochester and New York City seeking comments and recommendations from health care...more
On April 1, 2023, Medicaid members enrolled in mainstream Managed Care (MC) plans, Health and Recovery Plans (HARPs) and HIV-Special Needs Plans (SNPs) began receiving pharmacy benefits from NYRx, the pharmacy program under...more
On March 8, 2023, the New York State Office of the Medicaid Inspector General (“OMIG”) posted on its website a Compliance Program Review Module and a webinar that outlines the Compliance Program requirements for 2023 based...more
The New York Department of Health (DOH) announced March 8 that the 2022-2023 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual is available....more
On December 28, 2022, New York State Register published a summary of the New York State Office of the Medicaid Inspector General’s (“OMIG”) Notice of Adoption for Rulemaking on Medicaid Program Fraud, Waste and Abuse...more
The following is a summary of the federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported are...more
9/7/2022
/ Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Enforcement ,
False Claims Act (FCA) ,
Food and Drug Administration (FDA) ,
Fraud and Abuse ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare Fraud ,
Kickbacks ,
Medicaid ,
OIG ,
Paycheck Protection Program (PPP) ,
Qui Tam ,
Rebates ,
Trade Agreements Act
The following is a summary of the federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported are...more
8/19/2022
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Durable Medical Equipment ,
Enforcement ,
False Claims Act (FCA) ,
Fraud ,
Health Care Providers ,
Kickbacks ,
Medicaid ,
Medicare Fraud ,
OIG ,
Telemedicine
The following is a summary of the federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported are...more
8/9/2022
/ Bribery ,
Civil Monetary Penalty ,
Compliance ,
Department of Justice (DOJ) ,
Enforcement ,
False Claims Act (FCA) ,
Fraud ,
Kickbacks ,
Medicaid ,
OIG ,
Prior Authorization ,
Risk Assessment ,
Risk Management ,
Skilled Nursing Facility
On July 27, 2022, the New York State Office of Mental Health (OMH) published in the New York State Register an Emergency Rule Making related to Telehealth Services. These regulations make permanent many of the flexibilities...more
The following is a summary of the federal Health and Human Services agency’s Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported are based...more
7/8/2022
/ Anti-Kickback Statute ,
CARES Act ,
Centers for Disease Control and Prevention (CDC) ,
Compliance ,
Coronavirus/COVID-19 ,
Durable Medical Equipment ,
Enforcement ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Healthcare ,
Kickbacks ,
Medicaid ,
Medicare ,
Medicare Advantage ,
OIG ,
Opioid ,
Popular ,
Risk Assessment ,
Skilled Nursing Facility ,
TRICARE
The following is a summary of the federal Health and Human Services agency’s Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported are based...more
6/24/2022
/ Anti-Kickback Statute ,
Compliance ,
Controlled Substances ,
Department of Health and Human Services (HHS) ,
Enforcement ,
False Claims Act (FCA) ,
False Statements ,
Federal Debt Collection ,
Fraud and Abuse ,
Genetic Testing ,
Healthcare ,
Healthcare Fraud ,
Mail Fraud ,
Medi-Cal ,
Medicaid ,
Medicare Fraud ,
OIG ,
Popular ,
Risk Assessment ,
TRICARE ,
Wire Fraud