Medicare, OIG | JD Supra Law News

OIG Issues Updated Bulletin on Exclusion from Federal Health Care Programs

by Aaron Graham | Bradley Arant Boult Cummings LLP on 5/14/2013

On May 8, 2013, the Office of Inspector General (OIG) issued an updated Special Advisory Bulletin on the effect of exclusion from federal health care programs. A federal health care program (e.g., Medicare and Medicaid) is...more

HHS OIG Issues Report on Hospice General Inpatient Care Billing

by Howard Young | Morgan Lewis on 5/9/2013

Report makes no formal recommendations, but OIG notes that lengths of stay and frequency of general inpatient care are issues requiring further scrutiny....more

HHS Extends Sunset Date for Stark Exception and Anti-Kickback Safe Harbor for EHR Donations

by Daniel F. Gottlieb | McDermott Will & Emery on 4/19/2013

The Centers for Medicare & Medicaid Services and the U.S. Department of Health and Human Services issued proposed rules that would extend the sunset date for the Stark Law exception and the federal Anti-Kickback Statute safe...more

OIG Recommends Increased CMS Enforcement of SNF Standards

by Holly Barker, Kathleen McDermott | Morgan Lewis on 3/22/2013

Amid alleged failures of skilled nursing facilities to meet care and discharge planning requirements, OIG identifies substantial payment errors....more

OIG Report Critical of P&T Committee Oversight

by Theresa C. Carnegie, Ellyn L. Sternfield | Mintz Levin - Health Law on 3/12/2013

In a newly issued Report, the OIG has expressed concern regarding CMS’s lack of oversight of P&T Committee conflicts of interest. As the entities responsible for making Medicare Part D formulary decisions, P&T Committees...more

Health Care Enforcement in 2012: A Year in Review

by Hope Foster, Samantha Kingsbury, Tracy Miner, Jessica Sergi, Stephanie Willis | Mintz Levin - Health Law on 2/26/2013

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

Dealing with RAC Audits and Denials: How Healthcare Providers Can Manage Medicare Recovery Efforts

by Womble Carlyle Sandridge & Rice, PLLC on 2/26/2013

Executive Summary: Medicare RAC (Recovery Audit Contractor) audits are becoming increasingly aggressive, creating delays in payment for healthcare providers. Certain strategies can help mitigate delays caused by RAC audits...more

Expect Increased Medicare Denials for Incarcerated Beneficiaries and Unlawful Aliens

by Leslie Demaree Goldsmith | Ober|Kaler on 2/22/2013

The Department of Health and Human Services’ Office of Inspector General (OIG) recently published two reports finding Medicare improperly paid providers millions of dollars for incarcerated beneficiaries and unlawful aliens...more

The Healthcare Industry And The Voluntary Disclosure Process

by Michael Volkov on 2/21/2013

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

Hospitals And Fraud Enforcement

by Michael Volkov on 2/19/2013

The HHS Office of Inspector General has targeted hospitals for fraud enforcement. It is one of the OIG’s most important initiatives because of the impact it could have on reducing health care costs....more

OIG ?'s Co-Management Arrangement for Cardiac Cath Labs

by Daniel Murphy, Dinetia Newman | Bradley Arant Boult Cummings LLP on 2/8/2013

On January 7, 2013, the Department of Health and Human Services Office of Inspector General (“OIG”) posted a favorable advisory opinion concerning an existing co-management arrangement (“Arrangement”) between a large, rural,...more

CR7631: Changes to Place of Service Coding Effective April 1, 2013

by Stacey Borowicz, Simi Botic | Dinsmore & Shohl LLP on 2/7/2013

After the OIG identified a high error rate for Place of Service (“POS”) modifiers over several years, the Centers for Medicare and Medicaid (“CMS”) issued a billing and coding revision (CR 7631) to instruct any physician,...more

OIG Recommends that CMS Recoup More Than $100 Million in Overpayments for Incarcerated and Unlawfully Present Beneficiaries

by King & Spalding on 1/31/2013

CMS made more than $100 million in improper payments to providers for healthcare services on behalf of incarcerated and unlawfully present individuals between 2009 and 2011, according to a pair of reports issued on January...more

OIG Concludes in Nationwide Review of Drug That Herceptin Has Often Been Overbilled

by King & Spalding on 1/30/2013

The HHS OIG has conducted a nationwide audit of the use and reimbursement of Herceptin (also known as trastuzumab), a Medicare-covered drug used to treat metastatic breast cancer, and has concluded in three audits released in...more

OIG Report Calls for More Fraud and Abuse Investigations of Medicare Advantage Plans

by King & Spalding on 1/21/2013

The HHS OIG has released a report recommending that CMS grant the Medicare Drug Integrity Contractor (MEDIC) wider latitude in pursuing potential fraud and abuse by Medicare Advantage plans. The report found that the MEDIC,...more

OIG Advisory Opinion Sheds Light On Pay-For-Performance Relationships Between Hospitals And Physicians

by Darby C. Allen, Donna S. Clark | BakerHostetler on 1/20/2013

On January 7, 2013, the HHS OIG released Advisory Opinion 12-22 concerning a rural hospital's (Hospital) proposal to pay a cardiology group (Group) a performance bonus for achieving certain patient service, quality and cost...more

OIG: Cardiac Catheterization Arrangement Between Hospital and Physicians Not Subject to Sanctions

by King & Spalding on 1/18/2013

On January 7, 2013, HHS OIG published a favorable advisory opinion on a management arrangement between a hospital and a cardiology group related to the provision of certain cardiac catheterization services at the hospital. ...more

Health Reform + Related Health Policy News Update - January 16, 2013

by Colleen M. Faddick, Bruce A. Johnson, Matthew Murer, Alan K. Parver | Polsinelli on 1/18/2013

In This Issue: - Fiscal Cliff Deal Lengthens Medicare Overpayment Recovery Period - Cutting Medicaid Provider Tax May Shift Costs to States, CRS Finds - MedPAC Finalizes Payment Recommendations, GAO Solicits...more

Payment Matters: Extension of Time for Overpayment Recoveries in Fiscal Cliff Law Not as Broad as it Sounds

by Thomas W. Coons, Leslie Demaree Goldsmith | Ober|Kaler on 1/18/2013

The recently passed fiscal cliff legislation, i.e., the American Taxpayer Relief Act of 2012 (Act) [PDF], includes a number of provisions addressing Medicare and Medicaid. One of these provisions extends the recovery period...more

American Taxpayer Relief Act Amends Overpayment Recovery Time Limits

by Ameena Ashfaq, B. Scott McBride | BakerHostetler on 1/16/2013

The ATRA significantly alters provider rights related to overpayment recoupment, refunds, audits and claims appeals. A provision entitled "Removing obstacles to collection of overpayments" increases the statute of limitations...more

OIG Approves Gift Cards to Encourage Clinical Visits to Health Center

by Roy M. Albert, Theresa C. Carnegie | Mintz Levin - Health Law on 1/10/2013

In Advisory Opinion 12-21, the OIG concluded that a Federally qualified health center’s offer of grocery store gift cards to capitated managed care patients would not constitute grounds for the imposition of sanctions under...more

Fraud: Skilled Nursing Facilities And Nursing Homes

by Michael Volkov on 1/7/2013

When it comes to healthcare fraud enforcement, the government knows how to target its resources. It is estimated that at least 25 percent of all claims paid by Medicare are improper. The government understands the...more

Navigating the Provider Self-Disclosure Protocol

by Barbara Taylor | Sheppard Mullin Richter & Hampton LLP on 12/29/2012

Providers can voluntarily disclose potential fraud with respect to Federal health care programs — Medicare, Medicaid, and potentially private insurers to the extent Federal or state funds are involved — by following the...more

OIG’s Compendium of Unimplemented Recommendations Highlights Opportunities for Action in FY2013

by King & Spalding on 12/20/2012

The HHS Office of Inspector General (OIG) recently released its 2012 Compendium of Unimplemented Recommendations (the “Compendium”), a report that summarizes significant monetary and nonmonetary recommendations as a result of...more

OIG Recommends Additional Oversight of EHR Incentive Programs

by King & Spalding on 12/13/2012

A November 29, 2012 report from the HHS Office of Inspector General (OIG) sets forth several recommendations to improve CMS’s oversight of the Medicare and Medicaid EHR Incentive Programs. Specifically, the report expresses...more

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