News & Analysis as of

Fraud Abuse and Waste

CMS Again Extends HHA/Ambulance Enrollment Moratoria in Selected States to “Prevent and Combat Fraud, Waste, and Abuse”

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has once again extended for six months its “temporary” moratoria on the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollment of new nonemergency...more

Ruling Leaves Local Public Agencies Open to Legal Actions Asserting Wasteful Government Spending by Non Property Owners

by Best Best & Krieger LLP on

Cherrity Weatherford, who was a resident of the City of San Rafael in Marin County, rented (but did not own) property in the City. Although Weatherford’s vehicle was not impounded, she nonetheless took issue with the City’s...more

Confidentiality Agreement Rule Poses New HR-related Compliance Burden for Contractors

by Hogan Lovells on

While contractors (and their HR departments) dodged a serious bullet with Trump’s recent invalidation of the 2016 FAR blacklisting rule, they need to be alert to a new HR-related compliance requirement as a result of a rule...more

DOJ Intervenes in Risk Adjustment FCA Case

by Bass, Berry & Sims PLC on

Recently, the DOJ intervened in one of several currently pending qui tam cases involving Medicare Advantage (MA) and the Risk Adjustment process used to determine the amount of payments to Medicare Advantage Organizations...more

Time to Review Internal Confidentiality Agreements

by Foley & Lardner LLP on

Effective January 19, 2017, pursuant to Federal Acquisition Regulation (FAR) clause 52.203-19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements, federal government contractors are prohibited...more

"Republicans Chart New Course for US Health Care System"

While President Donald Trump made repeal of the Affordable Care Act (ACA) a centerpiece of his 2016 presidential campaign, he offered few details about how he would replace it or address other health care issues. More...more

Texas OIG Turns Over New Leaf: MCOs Must Turn Attention to SIUs

by Strasburger & Price, LLP on

More active SIUs may mean more scrutiny of Medicaid providers - The Texas Office of Inspector General (OIG) has just completed its first full year of reforms under a new Inspector General. 2017 may reveal whether these...more

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

by Baker Ober Health Law on

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

by Reed Smith on

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

by Reed Smith on

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

by Morgan Lewis on

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

by Hinshaw & Culbertson LLP on

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...

by Reed Smith on

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

by Reed Smith on

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...

by Dorsey & Whitney LLP on

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

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

by King & Spalding on

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

by Reed Smith on

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...

by King & Spalding on

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

by Cozen O'Connor on

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

by Cozen O'Connor on

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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