News & Analysis as of

Fraud Centers for Medicare & Medicaid Services (CMS) Office of the Inspector General

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
Hendershot Cowart P.C.

Doctors: Don’t Fall Victim To Telemedicine Fraud Schemes

Hendershot Cowart P.C. on

Telemedicine companies are supposed to facilitate medically necessary services to beneficiaries over the telephone via licensed medical professionals. In reality, however, many of these “telemedicine companies” are...more

Foley & Lardner LLP

HRSA Uninsured Program COVID-19 Services: What Were the Standards to Determine Uninsured Status?

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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

McDermott Will & Emery

Healthcare Regulatory Check-Up Newsletter | April 2023 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity for April 2023. We discuss several criminal and civil enforcement actions related to the Anti-Kickback Statute (AKS) and the...more

Mintz - Health Care Viewpoints

EnforceMintz — With Telemedicine Here to Stay, Enforcement Agencies Continued their Scrutiny

The Department of Justice and other federal enforcement agencies continued to hotly pursue individuals and entities involved in criminal telefraud schemes in 2022, as evidenced by the national coordinated law enforcement...more

Bass, Berry & Sims PLC

False Claims Act Fundamentals: Self-Disclosures

Bass, Berry & Sims PLC on

When healthcare providers and other government contractors are subject to scrutiny for bills submitted to the government, it is often the result of a whistleblower complaint filed under the qui tam provisions of the False...more

McDermott Will & Emery

OIG Medicare Telehealth Data Brief Demonstrates Continued Focus on Data Analytics in Program Integrity Efforts

McDermott Will & Emery on

On September 2, 2022, the US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released a data brief analyzing telehealth services covered by Medicare and related program integrity risks. OIG...more

ArentFox Schiff

OIG Reports Indicate the Government's Interest in Balancing Ongoing Telehealth Access With Increased Oversight

ArentFox Schiff on

A pair of reports recently issued by the US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) highlight the important role telehealth services have played in ensuring access to medical...more

Harris Beach PLLC

OIG Enforcement Summary: August 1, 2022 – August 15, 2022

Harris Beach PLLC on

The following is a summary of the 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 are...more

Goodwin

OIG Alert and DOJ Enforcement Action Summary: Telemedicine Arrangements

Goodwin on

The July 20, 2022 Special Fraud Alert describes findings from what OIG describes as “dozens of investigations of fraud schemes involving companies that purported to provide telehealth, telemedicine, or telemarketing services”...more

Venable LLP

HHS 2021 Semiannual Report to Congress Draws Attention to Genetic Testing, Durable Medical Equipment, and Opioid Disorder...

Venable LLP on

On June 6, 2022, the U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), released its spring 2022 semiannual report to Congress. The semiannual report covers the period of October 1, 2021 to...more

Mintz - Health Care Viewpoints

DOJ Announces Another Wide-Ranging COVID-19 Fraud Enforcement Action

For the last few years, we have been closely monitoring and reporting on COVID-19 related fraud enforcement efforts by federal agencies. We detailed those findings in our Health Care Enforcement 2020 Year in Review & 2021...more

Saul Ewing LLP

HHS OIG Releases Updated Health Care Fraud Self-Disclosure Protocol

Saul Ewing LLP on

On November 8, 2021, the United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) released an updated Self-Disclosure Protocol (SDP) (here). The revision of the SDP is an important...more

Foley & Lardner LLP

A Target on Telehealth: Government Action Against Telehealth Fraud in the Wake of COVID-19

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The COVID-19 Public Health Emergency (PHE) is expected to prompt unprecedented levels of regulatory enforcement activity that is focused on the use of telemedicine. In fact, fraudulent and abusive telehealth practices was an...more

Fox Rothschild LLP

DOJ Intensifies Criminal Prosecutions Of Health Care Fraud Related To COVID-19

Fox Rothschild LLP on

The Department of Justice (DOJ) has intensified its already aggressive crackdown on fraud related to COVID-19, recently announcing criminal charges against a telemedicine company executive, a physician, marketers and medical...more

King & Spalding

OIG Releases Semiannual Report to Congress

King & Spalding on

On May 28, 2021, OIG released its Semiannual Report to Congress (the Report). The Report describes OIG’s work during the 6-month semiannual reporting period of October 1, 2020, through March 31, 2021 (the Semiannual Reporting...more

Bass, Berry & Sims PLC

Improper Billing of “P-Stim” Devices is Focus of Recent FCA Settlements

Bass, Berry & Sims PLC on

Improper billing for electro-acupuncture using a “P-Stim” device (or peri-auricular stimulation device) has been the subject of two False Claims Act (FCA) settlements already in 2021, following a trend of such enforcement...more

ArentFox Schiff

Investigations Newsletter: HHS Announces Formation of FCA Working Group

ArentFox Schiff on

HHS Announces Formation of FCA Working Group - On December 4, 2020, the US Department of Health and Human Services (HHS) announced that it is creating a False Claims Act Working Group to enhance the partnership between...more

King & Spalding

OIG Issues Warning About Speaker Programs Sponsored by Drug and Device Companies

King & Spalding on

On November 16, 2020, OIG issued a significant Special Fraud Alert that warns about certain “inherent” fraud and abuse risks raised by speaker programs sponsored by pharmaceutical and medical device companies. OIG expressed...more

Rivkin Radler LLP

OIG Issues Special Fraud Alert On Speaker Programs

Rivkin Radler LLP on

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a Special Fraud Alert on November 16, warning that speaker programs organized by pharmaceutical and medical device companies pose...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 25. News Briefs: July 2020

Report on Medicare Compliance 29, no. 25 (July 13, 2020)  -  Ophthalmic Consultants PA in Sarasota, Florida, agreed to pay $4.8 million to settle false claims allegations that it billed Medicare and other federal payers...more

McDermott Will & Emery

OIG Penalties Expand to Grant and Contract Fraud

McDermott Will & Emery on

On April 21, 2020, the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a proposed rule that would amend its civil money penalty (CMP) regulations to address a 21st Century Cures Act...more

Seyfarth Shaw LLP

Insurers, ERISA Plans and Other Payors:  Beware of COVID-19 Fraud Schemes!

Seyfarth Shaw LLP on

On March 23, 2020, the U.S. Department of Health and Human Services Office of Inspector General (“HHS-OIG”) issued an alert to the public about fraud schemes related to the novel coronavirus (COVID-19)....more

Foley & Lardner LLP

Telemedicine and Digital Health Companies Will Benefit from Newly-Proposed Fraud and Abuse Waivers

Foley & Lardner LLP on

The OIG recently released proposed revisions to the Anti-Kickback Statute (AKS) and Civil Monetary Penalties (CMP) Law. Several of these changes, if finalized, will directly benefit companies offering telemedicine and digital...more

Epstein Becker & Green

OIG Portfolio Highlights Hospice Fraud and Quality-of-Care Concerns

Epstein Becker & Green on

On July 31, 2018, the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services released a portfolio titled “Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program...more

King & Spalding

CMS and OIG Propose First Major Medicaid Fraud Control Program Changes Since 1978

King & Spalding on

On September 20, 2016, CMS and the OIG jointly published a proposed rule, available here, to amend the largely unchanged 1978 regulation governing State Medicaid Fraud Control Units (MFCUs). Since the initial issuance of the...more

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