News & Analysis as of

Department of Health and Human Services (HHS) Federal Health Care Programs (FHCP)

Stevens & Lee

A New Arena for Future Challenges to CMS Regulations – the Overturn of Chevron

Stevens & Lee on

On June 28, 2024, the Supreme Court overruled Chevron, U.S.A., Inc. v. Nat. Res. Def. Council, Inc., and consequently invalidated the “Chevron Deference” — a cornerstone of administrative law since 1984. In the 6-3 decision...more

Foley & Lardner LLP

What Does the End of Chevron Deference Mean for Federal Health Care Programs?

Foley & Lardner LLP on

On June 28, 2024, the Supreme Court rejected the doctrine of Chevron deference in the closely watched case of Loper Bright Enterprises v. Raimondo. In a 6-3 decision, the Court held that Chevron’s rule that courts must defer...more

Harris Beach PLLC

OIG February 2024 Enforcement Actions

Harris Beach PLLC on

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

Mintz - Health Care Viewpoints

Key Takeaways from the OIG’s New Comprehensive General Compliance Program Guidance

The Department of Health and Human Services’ Office of Inspector General (OIG) published a General Compliance Program Guidance (GCPG) on November 6, 2023, marking the first update to OIG’s compliance program guidance...more

Proskauer - Health Care Law Brief

OIG Reaffirms Its Concern About “Carving Out” Federal Health Care Program Business

Last month, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services reaffirmed its longstanding position that an arrangement that “carves out” Federal health care program (FHCP) business is...more

Bass, Berry & Sims PLC

Expect the Expected: OIG Remains Suspicious of Suspect Contractual Joint Ventures in Advisory Opinion Involving IONM Industry

Bass, Berry & Sims PLC on

On August 18, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published Advisory Opinion 23-05, finding that an entity’s proposal to facilitate referring surgeons’ ownership of turnkey...more

Harris Beach PLLC

Office of Inspector Warns Against Proposed Surgeon-owned Turnkey Intraoperative Neuromonitoring Business

Harris Beach PLLC on

In a rarely seen “unfavorable” advisory opinion, the United States Department of Health and Human Services Office of Inspector General (“OIG”) recently warned that an entity’s (“Requestor”) proposal to assist surgeons in...more

Morgan Lewis

OIG Approves Per-Click Marketing Arrangement Involving Online Healthcare Directory

Morgan Lewis on

The US Department of Health and Human Services Office of Inspector General (OIG) recently released Advisory Opinion No. 23-04, which found that fraud and abuse risks were sufficiently low in light of certain safeguards to...more

Cozen O'Connor

Republican and Democratic AGs Air Conflicting Viewpoints on DACA Recipient Healthcare Eligibility

Cozen O'Connor on

A group of 19 Democratic AGs submitted a comment letter to HHS in support of a proposed rulemaking that would allow Deferred Action for Childhood Arrivals (DACA) recipients to qualify for federal health programs....more

Mintz - Health Care Viewpoints

OIGs Report on Expanded Telehealth Service Access and Use, Program Integrity Risks During Year One of COVID-19 Pandemic

The Pandemic Response Accountability Committee (PRAC) Health Care Subgroup recently published an expansive report that highlighted the sheer volume of expanded access to and use of telehealth services in certain federal...more

Kerr Russell

OIG Special Fraud Alert: Seven Suspect Characteristics of Fraudulent Telemedicine Arrangements

Kerr Russell on

It is no surprise that the use of telemedicine as a means of providing patients with access to medical care has increased significantly in recent years. Likewise, the number of telemedicine companies offering a broad range of...more

ArentFox Schiff

OIG Declines To Challenge Debt Cancellation and Restructured Financial Arrangements Between Health System and FQHC “Look-Alike”...

ArentFox Schiff on

In Advisory Opinion 22-17, the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) concluded that a proposed restructuring of a loan and other contractual relationships between a health system...more

Harris Beach PLLC

Gift Cards For Medicare Patients Not Inducements, OIG Opines

Harris Beach PLLC on

The Department of Health and Human Services’ Office of Inspector General (“OIG”) has offered an opinion on providing a gift card to certain Medicare Advantage plan enrollees who complete specific steps in an online patient...more

Smith Gambrell Russell

U.S. Government Issues Special Fraud Alert on Telemedicine Companies

The U.S. Government is warning health care practitioners to be on the lookout for fraud in connection with companies that offer products and services using telemedicine. On July 20, 2022, the U.S. Department of Health...more

Harris Beach PLLC

OIG Releases Special Fraud Alert on Telemedicine

Harris Beach PLLC on

On July 20, the Office of Inspector General (“OIG”) for the Department of Health and Human Services published a Special Fraud Alert on Telemedicine. Over the last year, as telehealth services expanded dramatically during the...more

Foley & Lardner LLP

OIG Special Fraud Alert on Arrangements with Telemedicine Companies

Foley & Lardner LLP on

On July 20, 2022, HHS-OIG published a new Special Fraud Alert on arrangements with telemedicine companies, setting forth seven characteristics OIG believes could suggest a given arrangement poses a heighted risk of fraud and...more

Harris Beach PLLC

OIG Decides Not to Impose Sanctions on Medical-Equipment Manufacturer in Financial Arrangement

Harris Beach PLLC on

Department of Health and Human Services Office of Inspector General (“OIG”) Advisory Opinion 22-13 Issued: June 23, 2022 This opinion addresses a durable medical equipment (“DME”) manufacturer’s arrangements with...more

Arnall Golden Gregory LLP

Analysis of Recent OIG Advisory Opinion on Employment of Excluded Individuals

The Department of Health and Human Services, Office of Inspector General (OIG) recently released a favorable advisory opinion, OIG Advisory Opinion No. 22-11 (the “Opinion”), analyzing the proposed employment of an individual...more

King & Spalding

OIG Publishes the Spring 2022 Semiannual Report to Congress

King & Spalding on

On June 6, 2022, OIG released its Semiannual Report to Congress (the Report) which summarizes the agency’s activities from October 1, 2021 through March 31, 2022 (the Reporting Period). Among other accomplishments, the...more

Rivkin Radler LLP

OIG Issues Favorable Advisory Opinion On Hospital/Physician Joint Venture ASC

Rivkin Radler LLP on

In a recent advisory opinion, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) concluded that certain investments by a health system, manager and physicians in an ambulatory surgery center...more

ArentFox Schiff

Senate Finance Committee Holds Confirmation Hearing For Top Biden HHS Nominees

ArentFox Schiff on

Deputy Secretary and CMS Administrator Picks Would Fill Two Critical Policy Positions - On Thursday, the Senate Finance Committee held a confirmation hearing for two of the most important health policy officials nominated...more

King & Spalding

HHS OIG Permits Labs to Offer Free COVID-19 Antibody Tests and Oncology Practices to Offer Free Lodging in Certain Circumstances

King & Spalding on

OIG has updated its FAQs regarding the application of its administrative enforcement authorities to arrangements directly connected with COVID-19 with the addition of two new FAQs. On August 4, 2020, the OIG issued an FAQ...more

King & Spalding

HHS Publishes Additional Terms and Conditions for Provider Relief Fund and FFCRA Payments

King & Spalding on

HHS has published additional Terms and Conditions associated with the acceptance of payments made from the $100 Billion Provider Relief Fund established pursuant to the Coronavirus Aid, Relief, and Economics Security Act...more

Baker Donelson

OIG's List of Excluded Individuals/Entities – What Employers Need to Know

Baker Donelson on

OIG maintains a list of all currently excluded individuals and entities called the "List of Excluded Individuals/Entities," or LEIE. Covered entities that hire – or continue to employ or work with – an individual or entity on...more

Baker Donelson

Administration Drug Pricing Proposals Could Reduce Provider Payments

Baker Donelson on

As the Trump Administration moves forward with proposed policy changes to address high drug prices, a common theme is emerging: a number of the proposals have the potential to reduce Medicare reimbursement to hospitals and...more

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