Each summer in recent years, the U.S. Department of Justice (DOJ) and associated fraud enforcement partners have indicted many health care defendants, in multiple cases across the country. This summer continued the tradition....more
8/29/2024
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Enforcement ,
Health Insurance ,
Healthcare ,
Healthcare Fraud ,
Kickbacks ,
Medicaid ,
OIG ,
Telehealth
Editor’s Note: PYA and Foley & Lardner hosted the 6th Annual “Let’s Talk Compliance” two-day Virtual Conference on January 18 and 19, 2024. Panelists included Foley & Lardner attorneys and PYA experts. The event was hosted by...more
2/2/2024
/ Business Operations ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Exclusions ,
Healthcare Fraud ,
Medicaid ,
Medicare Advantage ,
New Guidance ,
OIG ,
Risk Assessment ,
Self-Disclosure Requirements ,
Telemedicine
In connection with the November 2023 Health Care Compliance Association’s (HCCA) Healthcare Enforcement Compliance Conference, and with acknowledgment by the Chief Counsel to the Inspector General, Rob DeConti, of the long...more
11/8/2023
/ Advisory Opinions ,
Anti-Kickback Statute ,
Audits ,
Civil Monetary Penalty ,
Compliance ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Enforcement ,
Healthcare Fraud ,
OIG ,
Private Equity ,
Risk Assessment ,
Self-Disclosure Requirements
The Health Resources and Services Administration (HRSA) Uninsured Program (UIP), which reimbursed providers for provision of COVID-19 related services to uninsured individuals, paid out more than $24.5 billion in claims....more
8/18/2023
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
Enforcement ,
Fraud ,
HRSA ,
Medicaid ,
Medicare ,
Noncompliance ,
OIG
On July 13, 2023 the Office of Audit Services of the Department of Health & Human Services Office of Inspector General (OIG) released the long-awaited audit (A-02-21-01013) of the Health Resources and Services Administration...more
Continuing a now annual tradition, the Centers for Medicare & Medicaid Services (CMS) has included expansions and enhancements to its authorities to deny enrollment or revoke a provider’s Medicare billing privileges...more
7/18/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Diagnostic Tests ,
DMEPOS ,
Durable Medical Equipment ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Medicare ,
Misdemeanors ,
OIG ,
Proposed Rules ,
Revocation ,
Risk Assessment
One Health Resources and Services Administration program, “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured,” has been a huge source of...more
4/8/2022
/ American Rescue Plan Act of 2021 ,
CARES Act ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Department of Labor (DOL) ,
Families First Coronavirus Response Act (FFCRA) ,
Health Care Providers ,
HRSA ,
OIG ,
Reimbursements ,
U.S. Treasury
On November 8, 2021, the Department of Health & Human Services (HHS) Office of Inspector General (OIG) released a revised and renamed Provider Self-Disclosure Protocol: the OIG “Health Care Fraud Self-Disclosure” protocol...more
Two recent announcements reflect that the U.S. Government is taking aggressive steps to address opioid abuse by identifying and targeting the involvement of medical professionals in facilitating opioid abuse involving Federal...more
7/21/2017
/ Attorney General ,
Department of Justice (DOJ) ,
Drug & Alcohol Abuse ,
Health Care Providers ,
Medicare Fraud Strike Force ,
Medicare Part D ,
OIG ,
Opioid ,
Pharmacies ,
Physicians ,
Prescribing Authority
As required by a 2014 statute, CMS has issued proposed regulations (Proposed Rule) implementing new requirements for laboratory reporting of, and eventually basing Medicare payment on, rates for clinical laboratory services...more
10/12/2015
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
CLFS ,
Clinical Laboratories ,
Comment Period ,
Data Collection ,
Department of Health and Human Services (HHS) ,
Diagnostic Tests ,
Health Insurance ,
Hospitals ,
Managed Care Contracts ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part B ,
Misrepresentation ,
OIG ,
Omissions ,
PAMA ,
Physicians ,
Proposed Regulation ,
Reporting Requirements
The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2014 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCUs)...more
The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) on May 12, 2014 published a proposed rule (Proposed Rule) that would implement the OIG’s expanded authority under the Affordable Care...more
The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2013 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCU)...more
On January 9, 2014, the Health Resources and Services Administration (HRSA) posted an update on its current and anticipated 340B drug pricing program (340B) program integrity efforts.1 The update includes a discussion of...more