News & Analysis as of

Emerging EHR Risks: When Documentation May Not Be Enough (or Too Much)

Today’s Electronic Health Record (EHR) technologies feature many tools that help providers practice more efficiently and allow them to spend more time caring for patients. However, the federal government recently has posted...more

OIG Issues Report on Limited Compliance with Medicare’s Face-to-Face Requirement for Home Health Services

On April 9, 2014, the US Department of Health and Human Services Office of the Inspector General’s (OIG) Office of Evaluation and Inspections (OEI) issued a report (OEI-01-12-00390) entitled “Limited Compliance With...more

Summary of Clinical Laboratory Fee Schedule Reform Provisions in the Protecting Access to Medicare Act of 2014

On April 1, the Protecting Access to Medicare Act of 2014 was enacted into law (Pub. L. 113-93). Section 216, entitled Improving Medicare Policies for Clinical Diagnostic Laboratory Tests, modernizes the Medicare payment...more

OIG Issues Compendium of Unimplemented Priority Recommendations

On March 18, 2014, the OIG released its Compendium of Priority Recommendations (Compendium), which lists 25 broad “Priority Recommendations” for achieving “cost savings, improve program management, and ensure quality of care...more

OIG 2014 Work Plan – Skilled Nursing Facilities

Recently, the Department of Health and Human Services Office of the Inspector General (the “OIG”) released its work plan for 2014. The work plan provides stakeholders in the health care industry with a broad overview of the...more

OIG Targets Integrated Hospital Systems With Recommended Changes to Medicare’s 3-Day DRG Payment Window

On February 19, 2014, the Office of the Inspector General of the United States Department of Health and Human Services (“OIG”) released a report recommending two changes in the Medicare Diagnosis Related Group (“DRG”)...more

OIG Approves Medigap Policy Contracts with Preferred Hospital Networks

On February 20, the U.S. Department of Health & Human Services, Office of the Inspector General (OIG) released Advisory Opinion 14-02, concerning the use of preferred hospital networks as part of certain Medicare Supplemental...more

OIG Reports on Expansion of DRG Window

The OIG recently posted a report in which it recommended expanding the Diagnosis Related Group (DRG) payment window. In the February 2014 report (OEI-05-12-00480) (the “Report”), available here, the OIG analyzed both...more

2014 OIG Work Plan: Questionable Billing Patterns for Part B Services During Nursing Home Stays

The 2014 OIG Work Plan includes the following: Billing and Payments. We will identify questionable billing patterns associated with nursing homes and Medicare providers for Part B services provided to nursing home...more

2014 OIG Work Plan: Impact of Provider-Based Status on Medicare Billing

The 2014 OIG Work Plan includes the following: Policies and Practices. We will determine the impact of subordinate facilities in hospitals billing Medicare as being hospital based (provider based) and the extent to...more

OIG's 2014 Work Plan: A Roadmap to Key OIG Fraud and Abuse Priorities

The Department of Health and Human Services, Office of the Inspector General (OIG) released its Fiscal Year (FY) 2014 Work Plan on January 31, 2014. While the OIG usually releases its work plan in October of each year, in...more

OIG 2014 Work Plan Focuses On Compounded Pharmaceuticals Reimbursed By Medicare

The Office of Inspector General for the U.S. Department of Health and Human Services (“OIG”) included two items in its recently-released 2014 Work Plan indicating a new focus on the quality and safety of compounded...more

Healthcare Enforcement Actions and Trends: 2013 Overview

The Department of Justice (DOJ) and the Office of Inspector General for the U.S. Department of Health and Human Services continued aggressive enforcement of the healthcare industry in 2013. Officials employed a variety of...more

OIG Releases 2014 Work Plan

The OIG recently made available its 2014 Work Plan. The Plan identifies OIG focus areas and priority projects for the coming year. This post provides a brief summary of many of the new OIG projects for fiscal year 2014 to...more

OIG Scrutiny of Hospital Outpatient Evaluation/Management Claims Billed to Medicare

H.H.S’s Office of Inspector General’s yearly work plan was issued on 31 January 2014, which included numerous new and ongoing reviews and activities by OIG for the coming year. Among the new projects, OIG will review...more

OIG Releases Fiscal Year 2014 Work Plan

On January 31, 2014, the Department of Health and Human Services Office of Inspector General (OIG) released its work plan for fiscal year 2014. The work plan identifies the programs OIG will review in the upcoming year. The...more

Health Reform + Related Health Policy News - January 2014, Issue 1

In This Issue: - Top News ..Congress Approves Budget Deal with Short-Term ‘Doc Fix' ..CMS “Two-Midnight” Rule delayed until March 31, 2014 ..Individuals with Canceled Insurance Policies May Apply for...more

Health Care Providers May Waive Patients' Copayment Obligations, But...

In a difficult economic environment, many health care providers are actively trying to increase cash flow and reduce administrative expenses. One potential way for providers to accomplish these goals is to discount their...more

OIG Releases Study on MAC Performance

On January 8, 2014, OIG released a study of Medicare Administrative Contractors’ (MAC) performance between September 2008 and August 2011. The OIG found that while MACs met the majority of quality assurance standards...more

OIG Exclusion List: What it Means, What You Should Do

On January 8, 2014, the Office of Inspector General (“OIG”) updated the List of Excluded Individuals and Entities (“LEIE”). According to the LEIE, over 66,000 health care providers are currently excluded from all Federal...more

CMS And OIG Release Final Rules Extending Stark Law Exception And Anti-Kickback Statute Safe Harbor For Donations Of Electronic...

In 2006, the Centers for Medicare & Medicaid Services ("CMS") and the Office of Inspector General of the Department of Health and Human Services (the "OIG") published final rules providing for an exception to the Stark Law...more

Medicare Contractors Receive CMS Direction Regarding Recalcitrant Providers

CMS recently issued a transmittal providing guidance to Medicare program contractors on when and how to refer certain “recalcitrant providers” to CMS for potential sanctions under the Office of Inspector General’s (OIG) civil...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

OIG Calls for Increased Scrutiny on Hospital Outlier Payments

In a recent report [PDF], the Department of Health and Human Services Office of the Inspector General (OIG) highlighted hospital outlier payment trends it found troubling: Of the nearly 3,200 hospitals reviewed, approximately...more

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