News & Analysis as of

Office of the Inspector General

OIG Reports More Than $731 Million in Inappropriate Medicare Meaningful Use Payments

by McDermott Will & Emery on

The Electronic Health Records (EHR) Incentive Program run by Centers for Medicare and Medicaid Services (CMS) garnered attention again last week following the release of a report by the Office of Inspector General of the US...more

Labor Secretary Announces Aggressive Stance on Visa Fraud and Abuse

by Littler on

Secretary of Labor Alexander Acosta has announced that the Department of Labor (DOL) will more aggressively enforce laws governing the administration and enforcement of non-immigrant visa programs. The DOL will continue to...more

"Meaningfully Useful" Risk Mitigation Strategies for Providers Following the eClinicalWorks Settlement

by Jones Day on

The Health Information Technology for Economic and Clinical Health Act ("HITECH Act") established financial incentives under Medicare and Medicaid for eligible health care providers that adopt, implement, and demonstrate use...more

First Look at OIG’s FY 2017 Fraud Recoveries/Enforcement Activities

by Reed Smith on

The HHS Office of Inspector General (OIG) expects its investigative recoveries during the first half of fiscal year (FY) 2017 to top $2.04 billion – which is down from $2.77 billion for the first half of FY 2016. During this...more

Ch-Ch-Ch-Ch-Changes: Reporting Requirements for Updating Your CMS Provider Enrollment

by BakerHostetler on

With the possibility of significant penalties for improperly reported transactions, it is important to understand how certain changes necessitate specific reporting. Is your organization considering a stock transfer, a...more

OIG Targets Additional Medicare/Medicaid Policy Areas for Review

by Reed Smith on

The OIG has added 18 reviews to its FY 2017 Work Plan – most of which target CMS programs, with a particular emphasis on prescription drug policies. For instance, the OIG now intends to examine the following Medicare and...more

OIG Estimates CMS Made $730 Million in Improper EHR Incentive Payments, Based on Small Sample of Claims

by Reed Smith on

The HHS Office of Inspector General (OIG) estimates that CMS made $729.4 million in Electronic Health Incentive (EHR) payments to providers who did not meet meaningful use requirements from May 2011 to June 2014 –...more

OIG Issues FY 2016 Annual Report of the Medicaid Fraud Control Units

by Arnall Golden Gregory LLP on

The U.S. Department of Health and Human Services, Office of Inspector General (OIG) issued the Medicaid Fraud Control Units Fiscal Year 2016 Annual Report in May 2017. The Annual Report is based on analysis of statistical...more

OIG Faults CMS for its Medicare and Medicaid Improper Payment Rates

by King & Spalding on

Under the Improper Payments Information Act of 2002, as amended, the Department of Health and Human Services (HHS) is required to annually report on improper payments and meet certain improvement metrics. In a report...more

OIG Publishes Semiannual Report to Congress

Earlier this month, the Office of the Inspector General for the Department of Health and Human Services (“OIG”) published its Semiannual Report to Congress covering the period from October 1, 2016 to March 31, 2017. The...more

The Latest in the Epipen Medicaid Drug Rebate Saga – Where Are We Now?

The latest installment in the ongoing saga over EpiPen Medicaid Drug Rebates came on May 31, 2017, when Senator Charles Grassley issued a press release stating that between 2006-2016 taxpayers may have overpaid for EpiPen by...more

OIG Issues Top 25 Unimplemented Cost-Savings and Quality-Improvement Recommendations for HHS Programs

by Reed Smith on

The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has released the 2017 edition of its Compendium of Unimplemented Recommendations (“Compendium”). In the Compendium, OIG identifies...more

OIG reports on CFPB’s public website security controls

by Ballard Spahr LLP on

The Office of Inspector General for the Fed and CFPB has completed a report setting forth its findings from an audit in which it evaluated “selected security controls for protecting the [CFPB’s] consumerfinance.gov website...more

HCCA-OIG Resource Guide on Measuring Compliance Program Effectiveness

by Michael Volkov on

The Health and Human Services Office of Inspector General (OIG) and the Health Care Compliance Association (HCCA) jointly released a resource guide on measuring the effectiveness of a health care organization’s compliance...more

Seven Takeaways from the ABA National Institute On Health Care Fraud

On May 17, 2017 the American Bar Association convened its 27th National Institute on Health Care Fraud. I have attended many of the past annual meetings, and always enjoy the presentations and the opportunity to network with...more

Hospital and its Clinic Agree to $34 Million Settlement to False Claims Act Allegation that Compensation to Oncologists Violated...

Last week, the Department of Justice (DOJ) entered into a $34 million settlement with Mercy Hospital Springfield (“Hospital”) of Springfield, Missouri, and its affiliate Mercy Clinic (“Clinic”). The settlement resolves an...more

OIG Report Continues Criticism of CFPB Enforcement Data Security Practices

by Ballard Spahr LLP on

On May 15, 2017, the Federal Reserve Office of Inspector General – which also oversees the CFPB – released a report finding deficiencies in the CFPB Office of Enforcement’s (Enforcement) processes for securing sensitive...more

CMS Gamed System to Identify Hospitals Gaming System?

by Faegre Baker Daniels on

You can’t make this stuff up. When CMS conducted a study to identify hospitals that game the quality data reporting system, it used an approach that made the data reporting look better than it actually was. That bottom line...more

Why Healthcare and Life Sciences Companies Need to Step Up Their Compliance Efforts in Advance of a U.S. Government Investigation

by Hogan Lovells on

In this hoganlovells.com interview, Hogan Lovells partner Gejaa Gobena discusses how the perception of compliance, remediation, and self-disclosure has evolved in the eyes of government prosecutors from how they factor at...more

Repayment and Self Disclosure of Known Overpayments

by Ruder Ware on

The 60-day repayment rule adopted as part of the Affordable Care Act is a very strong arrow in the quiver of federal enforcement agencies. Under the 60-day rule a known overpayment can become a False Claim if it is not repaid...more

Stark Law: What Providers Should Know About New CMS Form

by Polsinelli on

The Centers for Medicare and Medicaid Services (CMS) has finalized Form CMS-10328 (the SRDP Form), a new OMB-approved information collection instrument that must be used by providers and suppliers utilizing the Stark Law...more

The OIG 2017 Work Plan Includes Focus on Hospitals - Corridors Newsletter April 2017

by Poyner Spruill LLP on

The U.S. Department of Health and Human Services (DHHS) Office of Inspector General (OIG) has issued its Work Plan for Fiscal Year 2017. The annual Work Plan provides a summary of new, revised, and continuing reviews for DHHS...more

Privacy Tip #85 – OIG Warns Consumers of Phone Call Scams by OIG Imposters

Phone call scams are on the rise. In addition to scam artists posing as employees of utility companies (see Privacy Tip #84), the Office of the Inspector General (OIG) has issued a warning to consumers about a phone scam...more

How Effective Is Your Compliance Program? New OIG and DOJ Guidance for Measuring the Effectiveness of Your Corporate Compliance...

by Dorsey & Whitney LLP on

Compliance programs are an important tool for health care providers. Compliance programs help to prevent fraud, waste and abuse, create a mechanism for catching problems early, and effective compliance programs can also...more

OIG Publishes Compliance Program Effectiveness Guide

by Arnall Golden Gregory LLP on

On March 27, 2017, the HHS Office of Inspector General (OIG) issued a document entitled “Measuring Compliance Program Effectiveness: A Resource Guide.” Published in conjunction with the Health Care Compliance Association...more

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