Office of the Inspector General Medicare

News & Analysis as of

Drug Manufacturer Discount Cards: Accept With Caution

Pharmaceutical manufacturer discount card usage by government program beneficiaries has been an active area for government action in recent years. In a September 2014 Special Advisory Bulletin, the U.S. Department of Health...more

DMEPOS Prior Authorization Rules Expand

On December 30, 2015, CMS published a final rule entitled: "Medicare Program; Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies," implementing Section 1834(a)(15) of the...more

Health Update - December 2015

Lessons from Hawaii's Trailblazing ACA 1332 Waiver Proposal - Editor's Note: On September 9, Hawaii became the first state to post a draft 1332 waiver proposal for public comment. While Hawaii's proposal focuses on the...more

2015 Health Care Year in Review

In 2015, ICD-10 finally became a reality, and the dire predictions of problems seem to be wrong. Providers now have codes to describe just about every conceivable (and a few simply bizarre) medical occurrences. If a patient...more

2016 Will Be the Year of Telemedicine and ACOs

If 2015 was the year that brought telemedicine directly to consumers, 2016 will be the year of telemedicine and Accountable Care Organizations (ACOs). ACOs are expected to increase the use of telemedicine technologies as a...more

Highlights From The 2016 OIG Work Plan

The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has released its Work Plan for Fiscal Year 2016. The annual work plan can provide valuable insights into the OIG’s planned areas of...more

Health Care Advisory: Highlights of the OIG’s 2016 Work Plan

On November 2, 2015, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) issued its Work Plan for Fiscal Year 2016 (“2016 Work Plan”).1 The 2016 Work Plan outlines the areas of...more

OIG Examines Medicare Part B Payments for 340B Purchased Drugs

A new OIG report reviews Medicare Part B spending on drugs purchased by eligible health care providers through the 340B drug discount program. The OIG describes the report as “an independent analysis to inform the ongoing...more

OIG Report Examines Potential Scenarios for Restructuring 340B Program

Restructuring the 340B Drug Discount Program and Part B payment rules could reduce Medicare drug expenditures by up to $1.1 billion, the HHS Office of Inspector General (OIG) reported last week. The 340B Program requires...more

OIG Work Plan Series – Installment Four – Oversight of Contracts

The Department of Health & Human Services’ Office of Inspector General (“OIG”) released its 2016 Work Plan, which includes the OIG’s focus on various aspects of federal government contracts. This alert will focus on the new...more

Tidbits and Takeaways from OIG’s 2016 Work Plan

The Office of Inspector General for Health and Human Services (“OIG”) recently issued its 2016 Work Plan, which sets the agenda for its auditing and investigation in the year ahead. The broad mandate of the OIG is to...more

Ignorance is Not Bliss: Get to Know the OIG FY 2016 Work Plan

The Department of Health and Human Services Office of Inspector General (HHS-OIG) recently released its FY 2016 Work Plan, in which it identified key areas of focus for the upcoming year. Consistent with its mandate to detect...more

OIG Work Plan Series Installment Two - Long Term Care - Nursing Homes, Hospice, and Home Health

In early November 2015, the Department of Health & Human Services’ Office of Inspector General (OIG) released its 2016 Work Plan, which includes projects specific to certain provider types. This alert will focus on the...more

HHS OIG FY 2016 Work Plan Outlines Oversight Priorities

The HHS OIG has released its FY 2016 Work Plan, which outlines the top audit, evaluation, and other legal and investigative initiatives that the OIG intends to conduct this fiscal year. As in years past, Medicare and Medicaid...more

OIG Policy Statement Outlines Conditions Under Which Hospitals May Waive Beneficiary Copayments for Outpatient Self-Administered...

The OIG has issued a policy statement clarifying the conditions under which hospitals may discount or waive Medicare beneficiary copayment amounts for self-administered drugs (SADs) received in outpatient settings without...more

OIG Workplan Series Installment One - What Does the OIG’s 2016 Work Plan Mean for Hospitals?

The Department of Health and Human Services’ Office of Inspector General (“OIG”) recently released its 2016 Work Plan. The Work Plan may offer evidence of a growing shift in the agency’s priorities, particularly with regard...more

OIG Releases FY 2016 Work Plan

On November 2, HHS OIG released its FY 2016 Work Plan. The Work Plan summarizes new and ongoing OIG reviews with respect to HHS programs and operations, providing an advance notice to the industry, policymakers, and the...more

OIG Issues Guidance Related to Free and Discounted Prescription Drugs Provided to Patients

HHS Office of Inspector General (OIG) recently clarified its guidance related to the provision of free or discounted prescription drugs in two contexts: (1) hospital discounts or waivers of self-administered drugs in...more

Limited Modifications in Final ACO Fraud and Abuse Waivers Most Notably Include Cut of Gainsharing CMP Waiver

Nearly four years after publishing their joint interim final rule with comment period, effective November 2, 2011 (IFC), the OIG and CMS (Agencies) have finalized the waivers of various fraud and abuse laws in the context of...more

CMS and OIG Issue Final ACO Waivers

On Thursday, October 29, 2015, the Centers for Medicare & Medicaid Services (“CMS”) and the Office of Inspector General (“OIG”) jointly issued a rule (the “Final Rule”) to finalize five (5) waivers of certain fraud and abuse...more

Blog: OIG Releases FY2016 Work Plan: Areas to be Reviewed Include SNFs, Drug Pricing, HIPAA

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released this week its FY2016 Work Plan (Work Plan). The OIG Work Plan summarizes new and ongoing OIG reviews of various HHS programs and...more

Millennium Health to Pay $256 million in False Claims Act Settlement

Millennium Health, one of the nation’s largest urine drug testing laboratories, has agreed to pay the government $256 million to resolve claims that it violated the Federal False Claims Act (“FCA”). The Settlement...more

OIG Issues Favorable Opinion Giving Green Light To Health System’s Shuttle Service

The Office of Inspector General (OIG) recently issued another advisory opinion on free patient transportation (OIG Adv. Op. No. 15-13, dated October 21, 2015). In the opinion, the OIG addresses whether providing patients a...more

Top Three Reasons ACOs Should Use Telehealth and Telemedicine

Accountable Care Organizations (ACOs) can share costs of telehealth and remote patient monitoring services among their hospitals, providers/suppliers, and other ACO participants, according to federal regulations under the...more

CMS/OIG Finalize Fraud Authority Waivers for Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program...

The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have finalized a rule designed to “remove legal and regulatory barriers that can impede care coordination in furtherance of the...more

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