The following is a summary of selected federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported...more
10/6/2023
/ Anti-Kickback Statute ,
Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
Enforcement ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Medicare Fraud ,
OIG ,
Popular ,
Self-Disclosure Requirements ,
Telemedicine ,
Wire Fraud
On September 21, 2023, the New York State Office of the Medicaid Inspector General (“OMIG”) posted on its website Compliance Program Requirements Frequently Asked Questions. OMIG intends the FAQs to supplement its Compliance...more
The New York Department of Health (DOH) adopted regulations effective on September 13, 2023, that revised Medicaid Utilization Review for Medicaid fee-for-service benefits. The regulations were initially published on April...more
The following is a summary of selected federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported...more
9/8/2023
/ CARES Act ,
Compliance ,
Coronavirus/COVID-19 ,
Corporate Integrity Agreement ,
Deferred Prosecution Agreements ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Economic Injury Disaster Loans ,
Enforcement ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Medicare Advantage ,
Medicare Fraud ,
OIG ,
Paycheck Protection Program (PPP) ,
Popular ,
Risk Assessment
In its August 15, 2023, Enforcement listserv notice, the U. S. Department of Health and Human Services Office of Inspector General (“OIG”) published its Work Plan Updates for August. This article will highlight three of the...more
8/28/2023
/ Audits ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Grants ,
Healthcare Facilities ,
HRSA ,
Medicare ,
Medicare Part B ,
OIG ,
Opioid ,
Over The Counter Drugs (OTC) ,
Public Health Emergency ,
Substance Abuse ,
Virus Testing ,
Work Plans
On August 21, 2023, the New York State Office of the Medicaid Inspector General (“OMIG”) updated its Medicaid Self-Disclosure Program Requirements. The updated Instructions and Guidelines announce a new “Abbreviated”...more
Harris Beach invites you to register for its 7 Element compliance program series addressing New York’s 2020 and 2022 updates to Medicaid Compliance Program requirements. Starting on August 16th, each live program will be no...more
8/10/2023
/ Anti-Kickback Statute ,
Compliance ,
Department of Health and Human Services (HHS) ,
Enforcement ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Medicare Fraud ,
Money Laundering ,
OIG ,
Opioid ,
Risk Management ,
Telemedicine
The U.S. Department of Health and Human Service’s Office of Inspector General published two Adverse Events Toolkits on July 6 to assist health care providers, government agencies and researchers identify and measure adverse...more
The New York State Office of the Medicaid Inspector General (“OMIG”) recently posted on its website a Compliance Program Self-Assessment Form that OMIG developed as a resource for providers to help them assess their...more
The Department of Health and Human Services’ Office of Inspector General (“OIG”) willmodernize its Compliance Program Guidance (“CPG”) beginning at the end of calendar year 2023. The updates will be posted on the OIG website...more
The New York State Office of the Medicaid Inspector General (“OMIG”) conducted three statewide sessions to outline its audit process as it pursues its mission to prevent and detect fraud, waste and abuse in the Medicaid...more
The COVID-19 Federal Public Health Emergency (“PHE”) is scheduled to end on May 11, 2023. With the end of the PHE, a number of the federal and New York state agencies’ regulatory flexibilities put into effect during the PHE...more
The COVID-19 Federal Public Health Emergency (“PHE”) is scheduled to end on May 11, 2023. With the end of the PHE, a number of the federal and New York state agencies’ regulatory flexibilities put into effect during the PHE...more
The New York State Office of the Medicaid Inspector General (“OMIG”) announced March 30 it will host provider engagement forums in Albany, Rochester and New York City seeking comments and recommendations from health care...more
On April 1, 2023, Medicaid members enrolled in mainstream Managed Care (MC) plans, Health and Recovery Plans (HARPs) and HIV-Special Needs Plans (SNPs) began receiving pharmacy benefits from NYRx, the pharmacy program under...more
On March 8, 2023, the New York State Office of the Medicaid Inspector General (“OMIG”) posted on its website a Compliance Program Review Module and a webinar that outlines the Compliance Program requirements for 2023 based...more
The New York Department of Health (DOH) announced March 8 that the 2022-2023 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual is available....more
The New York Department of Health (DOH) announced on November 17 that the Healthcare Worker Bonus (HWB) Program will expand to include additional titles and eligible provider types. On January 13, DOH announced the opening...more
On December 28, 2022, New York State Register published a summary of the New York State Office of the Medicaid Inspector General’s (“OMIG”) Notice of Adoption for Rulemaking on Medicaid Program Fraud, Waste and Abuse...more
The New York Department of Health (DOH) announced November 30th it is releasing a survey for enrolled Medicaid providers who meet the eligibility criteria for the Healthcare Worker Bonus (HWB) Program, but are enrolled in...more
The New York Department of Health (DOH) announced on November 17th that the Healthcare Worker Bonus (HWB) Program was being expanded to include additional titles and eligible provider types. For a list of the new qualified...more
The New York Department of Health (DOH) announced on October 31st it was extending the deadline for claim submissions on the Healthcare Worker Bonus (HWB) Portal until November 30. While DOH notes claims submitted after...more
Vesting Period 2 covers the period April 1, 2022 through September 30, 2022. The New York State Department of Health opened the Healthcare Worker Bonus Program Portal to facilitate submissions by eligible employers on behalf...more
Recently, the Office of Inspector General (“OIG”) for the Department of Health and Human Services published its Report on Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks...more
This opinion regards a proposed restructuring of financial relationships, which includes the forgiveness of debt, between a health system and a nearby clinic.
...more