News & Analysis as of

OIG Report Outlines Five Recommendations for Hospice Care Reform

The Patient Protection and Affordable Care Act requires the Centers for Medicare and Medicaid Services (“CMS”) to reform the hospice payment system, collect data relevant to revising hospice payments and develop quality...more

OIG Advisory Opinion Sheds Light on Preventive Care Exception

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued an advisory opinion approving an arrangement whereby a licensed entity providing services under a state program for...more

OIG Issues Advisory Opinion Regarding Free Items Provided By State Maternal Infant Health Program

On February 2, 2015, OIG posted a favorable Advisory Opinion regarding the provision of certain free items to Medicaid beneficiaries by a state maternal infant health program (the “Program”). The Program is designed to...more

This Just in: OIG Rules Free Diapers Are Not an Illegal Kickback

The February Profile in Courage Award goes to the Office of Inspector General (OIG) of the Department of Health & Human Services. In its very first Advisory Opinion of the year, the OIG has boldly proclaimed that a provider...more

OIG Report Recommends Reforms to Reduce Hospice Incentives to Provide Care in Assisted Living Facilities

On January 14, 2015, OIG published a report that analyzes Medicare payments for hospice care in assisted living facilities (ALFs). OIG concluded that CMS should implement measures to reform Medicare payments to hospices,...more

Health Law Pulse - January 2015

In This Issue: - Connecticut Supreme Court Rules State Does Not Recognize Mature Minor Doctrine - OIG Issues Advisory Opinion Permitting Copayment Assistance - CMS Announces Recovery Audit Program...more

OIG Questions Incentives for Hospice Care in Assisted Living Facilities

Today the OIG issued a report examining the growing use of Medicare hospice care in the assisted living facility (ALF) setting. According to the OIG, Medicare payments for hospice care in ALFs grew by more than 119% from 2007...more

OIG Recommends Greater Scrutiny for Hospice Services in ALFs

The OIG’s recently released study examining Medicare hospice claims from 2007 to 2012 calls for targeted reviews of hospices that receive a high proportion of their payments for care in assisted living facilities....more

OIG Approves Nonprofit Foundation's Proposed Copayment Assistance Program

On January 5, 2015, the OIG posted a favorable advisory opinion, OIG Advisory Opinion 14-11, regarding a 501(c)(3) charitable foundation’s (Foundation) proposal to establish a patient assistance program that would provide...more

What You Need To Know About the AKS Proposed Local Transportation Safe Harbor

On October 3, 2014, the Office of Inspector General of the U.S. Department of Health and Human Services (OIG) published a proposed rule to expand the safe harbors and make other modifications applicable to the federal...more

OIG Provides Leeway for Copay Assistance to Low-Income Patients

Earlier this week the OIG released an advisory opinion stating that a nonprofit organization’s proposed arrangement to provide copayment assistance to financially needy patients would not result in civil monetary penalties or...more

Challenges Physicians Can Expect in 2015

Reimbursement for medical services continues to decline. Continuing uncertainty about the Affordable Care Act persists. Government regulations create burdensome paperwork, busywork, and compliance headaches. Technology costs...more

Skilled Nursing Facilities: Steps for Reducing FCA Liability

Several government agencies have voiced concerns related to the level of therapy services necessary to care for residents of Skilled Nursing Facilities (SNFs). The level of therapy services indicated for SNF residents...more

OIG Soliciting New Anti-Kickback Safe Harbor Suggestions

In the December 30, 2014 Federal Register, the OIG solicited comments on potential new or modified safe harbors under the federal Anti-Kickback Statute. Comments are due by March 2, 2015, and the OIG requested that any...more

2014 – The Health Law Year in Review

Each year brings significant changes and challenges in the laws governing the health care industry, and 2014 proved to be no exception. What the year may have lacked in the high drama that accompanies comprehensive health...more

Blog: HHS OIG Releases Annual Solicitation for New and Modified Anti-Kickback Safe Harbors and for New Special Fraud Alerts

On December 29, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released its annual solicitation (the “Solicitation”) for proposals and recommendations for developing new and modifying...more

OIG Releases Fiscal 2014 Report to Congress

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS) released its Semiannual Report to Congress (Report) last week summarizing health care fraud investigation activities for the...more

Buy High, Sell Low, and Restrict Competition: The Allegations Underlying the Government’s Case Against DaVita and the Implications...

On October 22, DaVita HealthCare Partners Inc., one of the nation’s largest dialysis companies, and its wholly owned subsidiary, Total Renal Care, Inc. (collectively, “DaVita”), agreed to pay $389 Million to settle...more

Health Care Update - December 2014 #4

Let’s Get to Work: OIG Releases 2015 Work Plan, Focusing on Long-Term Care and Health Reform - The U.S. Department of Health and Human Services (HHS)--Office of Inspector General (OIG) released its 2015 Work Plan (Work...more

OIG Report: MCOs Cause Limited Access to Primary Care for Medicaid Enrollees!

With flu season well under way, access to care to primary care physicians for Medicaid recipients is (as it is always) extremely important. During flu season, in particular, emergency rooms (ERs) are full of people suffering...more

HHS to Audit Hospital Reporting of GPO Payments: GAO Report Suggests Further Scrutiny of GPO Shareback with Hospitals

On November 24, 2014, the Government Accountability Office (“GAO”) published a report examining the contracting practices and funding structures of health care group purchasing organizations (“GPOs”) and their potential...more

OIG Again Approves Medicap Insurer's Contract with Preferred Hospital Network

On October 21, 2014, the Department of Health and Human Services, Office of Inspector General (OIG) issued Advisory Opinion 14-10, approving a Medigap insurer’s proposed contract with a preferred hospital network. Similar to...more

The Game Plan for Health Care Enforcement: Office of Inspector General Releases 2015 Work Plan

The Office of Inspector General (“OIG”) within the federal Department of Health and Human Services (“HHS”) is charged with protecting the integrity of HHS programs by combating fraud, abuse and waste. On Halloween of 2014,...more

HHS OIG Announces Information Security Initiatives in 2015 Work Plan

The 2015 Work Plan of the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) posted on Friday, October 31, 2014, includes initiatives focused on testing information security controls related to...more

Arrangements between Laboratories and Referring Physicians Involving “Registries”

The United States Office of Inspector General (“OIG”) recently issued a “Special Fraud Alert” focusing on two potentially illegal trends that it has detected in arrangements between laboratories and their referring...more

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