Fraud Abuse and Waste

News & Analysis as of

CMS Lifts Temporary Moratorium on Emergency Ground Ambulance Suppliers but Extends and Expands Other Moratoria

On July 29, 2016, CMS announced that it is lifting a temporary moratorium on Medicare Part B, Medicaid, and Children's Health Insurance Program (CHIP) emergency ambulance suppliers, but extending and expanding similar...more

CMS Announces Changes to HHA/Ambulance Supplier Enrollment Moratoria, New Exception Process Demo

CMS has announced a number of changes to its temporary Medicare enrollment moratoria for certain provider types in select geographic areas as a mechanism to address fraud, waste, and abuse. First, CMS is extending for six...more

OIG, CMS Focus New Scrutiny on Home Health Industry: Additional Investigative and Enforcement Activity Likely to Follow

On June 22, 2016, the Department of Health and Human Services Office of Inspector General (“OIG”) issued a comprehensive report detailing its nationwide analysis of common characteristics in home health fraud cases. In tandem...more

Senate Finance Committee Examines Repeal of the Stark Law

A new report suggests that the Stark law is obsolete in new payment models. On June 30, the US Senate Committee on Finance (the Committee) released the report Why Stark, Why Now? Suggestions to Improve the Stark Law to...more

OIG Mid-Year Updated Provides Insight To Its Concerns

The Office of Inspector General (OIG) recently released its mid-year update of its Fiscal Year Work Plan for 2016. The Work Plan summarizes new and ongoing reviews and activities that the OIG plans to pursue. Not...more

CMS Proposes Program Integrity Enhancements to the Provider/Supplier Enrollment Process, including New Affiliated Provider...

On March 1, 2016, CMS published a proposed rule that would make a variety of changes to the Medicare, Medicaid, and CHIP provider and supplier enrollment requirements. CMS believes that the proposal would assist in ensuring...more

Obama Administration Releases FY 2017 Budget Proposal with Extensive Medicare & Medicaid Funding and Program Integrity Provisions

On February 9, 2016, the Obama Administration released its proposed fiscal year (FY) 2017 budget, which contains significant Medicare and Medicaid reimbursement and program integrity legislative proposals – including $419...more

Proposed Federal Rule Says Government Contractors Cannot Prevent Employee from Reporting Fraud, Waste or Abuse

Over the past several years, a series of Executive Orders and federal rules have significantly changed the relationship between federal contractors and their employees. These new rules have included protections for certain...more

Internal Confidentiality Agreements: 5 Things all Government Contractors Need to Know About the New Proposed FAR Rule

On January 22, 2016, the Federal Acquisition Regulatory (FAR) Council issued a Proposed Rule prohibiting government contractors from using internal confidentiality agreements to restrict employees or subcontractors from...more

Proposed Rule Would Restrict Confidentiality Agreements Between Contractors and Their Employees

On January 22, 2016, the Department of Defense, General Services Administration, and National Aeronautics and Space Administration proposed a new rule that would amend the Federal Acquisition Regulation to implement a section...more

Proposed Federal Rule Would Proscribe Contractor Confidentiality Agreements that “Restrict” Employees And Subcontractors from...

A recently proposed amendment to the Federal Acquisition Regulation precludes Federal contractors from entering into a confidentiality agreement with an employee or subcontractor that “prohibit[s] or otherwise restrict[s]”...more

Contractors Beware: An Overly Broad Confidentiality Agreement Could Cost You!

On October 29, 2015, DOD renewed the DFARS deviation implemented in February, which prohibits contracting with entities that require employees or subcontractors to sign internal confidentiality agreements or statements that...more

Tidbits and Takeaways from OIG’s 2016 Work Plan

The Office of Inspector General for Health and Human Services (“OIG”) recently issued its 2016 Work Plan, which sets the agenda for its auditing and investigation in the year ahead. The broad mandate of the OIG is to...more

Health Update - September 2015

Latest Healthcare False Claims Act Roundup and Top 3 Best Practices to Reduce Exposure - As the legal landscape in healthcare becomes increasingly complex, healthcare companies that receive federal program funds face...more

OIG Releases Report on Questionable Billing for Medicare Ophthalmology Services

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

House Energy & Commerce Committee Schedules Hearing to Review Medicaid Program Integrity Legislation

On September 11, 2015, the House Energy & Commerce Subcommittee on Health will hold a hearing to discuss legislative proposals intended to reduce Medicaid waste, fraud, and abuse. Bills to be discussed include...more

GAO Director for Healthcare Provides Recommendations for CMS to Combat Fraud, Waste and Abuse in the Medicare Program in Testimony...

On June 25, 2014, Kathleen M. King, Director of Health Care for the Government Accountability Office (GAO) testified before the House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations explaining...more

Health Care Reform Implementation Update - April 26, 2013

Marilyn Tavenner received bipartisan support from members of the Senate Committee on Finance in her confirmation hearing to lead the Centers for Medicare and Medicaid Services (CMS) though a full Senate vote is being held up,...more

OIG Reports on Questionable Billing for Mental Health Services

As its title makes clear, the August 2012 report “Questionable Billing by Community Mental Health Centers” (the Report) by the U.S. Department of Health and Human Services Office of Inspector General (OIG) demonstrates its...more

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