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Health Care Providers › Fraud Abuse and Waste › Centers for Medicare & Medicaid Services (CMS)

Stevens & Lee

New Changes to Medicare and Private Prior Authorization Processes

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Both the Centers for Medicare & Medicaid Services (CMS) and dozens of the nation’s largest insurance companies have revealed upcoming changes to their prior authorization processes. These changes aim to reduce the prevalence...more

Holland & Knight LLP

OIG Releases New Compliance Program Guidance for All Healthcare Stakeholders

Holland & Knight LLP on

The Office of Inspector General of the U.S. Department of Health and Human Services (OIG) on Nov. 6, 2023, issued new General Compliance Program Guidance (GCPG) as a reference guide for the healthcare compliance community....more

Benesch

OIG Provides Insight as to Risky Billing Practices for Medicare Telehealth Services

Benesch on

​​​​​​​As part of the Federal government’s response to the COVID-19 pandemic, the coverage of telehealth services by Medicare was greatly expanded by CMS through the COVID-19 telehealth waivers. Further expansion of...more

Health Care Compliance Association (HCCA)

[Event] Research Compliance Conference - June 8th - 10th, Anaheim, CA

Health Care Compliance Association (HCCA) on

Hear about the latest in research compliance - Do you want to learn… - How to prepare for upcoming changes in Medicaid? - Ways to build and maintain a better research compliance work plan for your program? - How...more

Health Care Compliance Association (HCCA)

[Virtual Event] 2022 Managed Care Compliance Conference - February 8th - 9th, 8:25 am - 3:45 pm CST

Health Care Compliance Association (HCCA) on

Can’t attend the conference in-person? The virtual Managed Care Compliance Conference, February 8–9, allows you to hear from industry professionals just like you—all from the comfort of your home or office. Geared towards...more

Goodwin

OIG Advocates for Increased Oversight of Medicaid Telehealth Services in Behavioral Health

Goodwin on

Telehealth’s exponential growth –in part due to the COVID-19 pandemic – has highlighted both its value in increasing access to care and the potential for misuse. The U.S. Department of Health and Human Services’ Office of...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 30, Number 13. News Briefs: April 2021

Health Care Compliance Association (HCCA) on

Report on Medicare Compliance 30, no. 13 (April 5, 2021) - Because of the COVID-19 pandemic, CMS said April 1 that it won’t update the 855 enrollment form with sections on “affiliation disclosures,” as planned in a 2019...more

Baker Donelson

Medicare Revocation Consequences Worsened – Further Reenrollment Restrictions

Baker Donelson on

CMS recently finalized the most significant changes to enrollment since the 2006 enrollment rules were initially adopted. Overview of the New Rule - In its "Program Integrity Enhancements to the Provider Enrollment...more

King & Spalding

CMS Announces New Market Saturation and Utilization Tool

King & Spalding on

In an August 30, 2019 press release, CMS announced the launch of a new tool, which CMS has titled the “Market Saturation and Utilization Data Tool.” The tool is available here through the CMS website. CMS’s stated purpose for...more

King & Spalding

OIG Releases Report on Questionable Billing for Medicare Ophthalmology Services

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On September 15, 2015, OIG released a report examining the extent to which ophthalmology services are vulnerable to fraud, waste, and abuse. According to OIG, Medicare paid $6.7 billion to 44,960 providers for ophthalmology...more

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