Fraud Healthcare Office of the Inspector General

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
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Medicaid Claims And Health Care Fraud: As The Data Flows, New Cracks Emerge

As we noted in two of our prior posts in the Insider blog, the government has long touted its ability to rely upon data mining as a means of detecting fraud in the federal health care system, and has initiated a host of...more

New OIG Special Fraud Alert Aimed at Laboratory Payments to Referring Physicians

On June 25, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert entitled "Laboratory Payments to Referring Physicians."...more

OIG Issues Special Fraud Alert on Lab/Physician Arrangements

The Office of the Inspector General (“OIG”) has issued another Special Fraud Alert, this time specifically targeting a recent trend in arrangements between laboratories and physicians. The alert describes two types of...more

The Intractable Problem of Medicare Fraud

You have to admire the vigilance and dedication of prosecutors and law enforcement investigators who fight Medicare fraud. There is no question that they have ramped up enforcement and promoted a strong message of deterrence....more

OIG Releases Special Fraud Alert on Laboratory Payments to Physicians

The Office of the Inspector General (OIG) for the Department of Health and Human Services recently issued a Special Fraud Alert regarding laboratory payments to referring physicians. The Special Fraud Alert reaffirms OIG’s...more

News from the Health Law Gurus™: Week of May 11th, 2014

News from the Health Law Gurus™ is a weekly summary of notable health law news from around the country with helpful links to related content. ...more

OIG Releases Report on EHR Fraud Controls

On December 11, 2013, the HHS Office of Inspector General (OIG) released a report examining provider use of certain fraud controls in certified electronic health record (EHR) technology. OIG’s survey of 864 hospitals found...more

Health Care Fraud and Abuse Alert: What CMS’s New Billing Requirement For “Incident To” Services Means For Medicare Providers.

In the final Medicare Physician Fee Schedule for 2014 (“2014 PFS”), CMS implemented a new condition of payment for “incident to” services that has significant fraud and abuse implications for any Medicare provider who relies...more

2013 Healthcare Year In Review

Bob Dylan's quote from 1964 -- "The Times They Are A-Changin" -- could equally apply to the healthcare industry in 2013. This was the year that the Affordable Care Act ("ACA") came into full public view with the start of the...more

Health Reform + Related Health Policy News - October 2013 - Issue 3

In This Issue: - Top News ..Deal to Raise Debt Ceiling, End Shutdown Yields No Major Changes to Health Care Law ..Problems with HealthCare.gov Website Continue; HHS Working to Fix Issues ..Kaiser Study...more

Lawsuit Based on Kickback, Stark Law Violations Sustained; Civil Suit Offers Additional Option to Counter Competitor's Illegal...

Hospitals, laboratories, and other health care providers that rely on referrals from other health professionals may encounter situations where competitors have entered into arrangements with physicians or other referral...more

Foundations in Fraud and Abuse: Building Blocks of Health Law

The Ober|Kaler Health Care General Counsel Institute is pleased to introduce its Foundations series, a collection of programs designed to equip in-house counsel with a solid foundation in the cornerstones of health law. The...more

OIG Publishes Audit of Outpatient Therapy Services Seeking Return of $3.1 Million in Reimbursements

In June 2013, the Department of Health and Human Services, Office of Investigator General (OIG) published a review of its audit of an outpatient therapy services provider. The OIG concluded that the outpatient therapy...more

Health Care E-Note - June 19,2013

In This Issue: - FTC Hospital Merger Investigation Highlights Cost of Health Care - Survey Finds Doctors Warming to Health Information Exchanges - Health Insurance Markets Seeing More Competition from New...more

OIG Semiannual Report Announces Expected Recoveries of Nearly $4 Billion for October 2012 – March 2013

In its Semiannual Report to Congress, which covers the first half of fiscal year (FY) 2013 (October – March), the OIG announced expected recoveries of $3.8 billion, consisting of more than $521 million in audit receivables...more

Health Reform + Related Health Policy News - May 2013

In This Issue: - Top News ..Tavenner Wins Senate Confirmation to Head CMS ..US Charges 89 in Nationwide Medicare Fraud Crackdown - State News ..Vermont Becomes Fourth State to Allow Physician-Assisted...more

The Top 10 Things You Need To Know About The OIG’S Revised Self-Disclosure Protocol

On Wednesday, April 17, 2013, the Department of Health and Human Services’ Office of Inspector General (OIG) released an updated Self-Disclosure Protocol (SDP) governing the process by which health care providers can...more

OIG Special Fraud Alert Labels Physician-Owned Distributorships (PODs) as “Inherently Suspect”

The U.S. Department of Health & Human Services, Office of Inspector General (the “OIG”) issued a Special Fraud Alert (“Alert”) on March 26, underscoring its heightened focus on fraud and abuse risks posed by physician-owned...more

OIG Special Fraud Alert on Physician-Owned Distributorships

On March 26, 2013, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert entitled “Physician-Owned Entities.” The Alert is consistent with an ongoing theme of concern...more

OIG Issues Special Fraud Alert on Business Arrangements with Physician-Owned Entities

On March 26, the HHS Office of Inspector General (OIG) issued a Special Fraud Alert (Fraud Alert) reiterating its long-standing concern that the opportunity for a referring physician to earn a profit by investing in a venture...more

Increased Government Scrutiny of Physician-Owned Device Distributorships

On March 26, 2013, the Office of Inspector General of the U.S. Department of Health and Human Services (OIG) increased its scrutiny of and pressure on physician-owned entities (particularly medical device distributorships) by...more

OIG Calls PODs "Inherently Suspect"

Making its most strongly worded statement to date, the Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert on Physician-Owned Entities on March 26, 2013, calling...more

Physician-Owned Device Companies: OIG Issues Further Guidance

The Office of the Inspector General for the United States Department of Health and Human Services (OIG) issued a Special Fraud Alert on March 26, 2013 (the "2013 POD alert"), that identifies physician-owned distributorships...more

Health Care Enforcement in 2012: A Year in Review

Last year was another busy year in health care fraud enforcement. In 2012, the Office of Inspector General for the Department of Health and Human Services (HHS-OIG) reported total expected recoveries of $6.9 billion from all...more

The Healthcare Industry And The Voluntary Disclosure Process

It is always important to consider how different parts of the government handle voluntary disclosures. The FCPA enforcement initiative has been largely the result of the voluntary disclosure process, and the government...more

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