News & Analysis as of

Medicare Office of the Inspector General

Telehealth Reaches Tipping Point – Now Included in OIG Audit Plan

by Tucker Arensberg, P.C. on

Telehealth has apparently reached the tipping point in its significance to the Medicare budget, because OIG has now announced that it will “review Medicare claims for telehealth services provided at distant sites that do not...more

Self-Administered Versions of Orencia and Cimzia Were Included In Calculating Medicare Part B Payment Costs Which Significantly...

by King & Spalding on

A report issued by the OIG on November 21, 2017 found that inclusion of the more costly self-administered versions of Orencia and Cimzia when calculating Medicare Part B costs caused Medicare and its beneficiaries to pay an...more

Legislation, Lawsuit Cloud Future of 340B Program Payment Rate Reductions

by Jones Day on

The Situation: A Final Rule published by the Centers for Medicare & Medicaid Services carries a provision that reduces reimbursement for most 340B Program drugs dispensed by disproportionate share hospitals and rural referral...more

OIG Rescinds Advisory Opinion Due to Requestor’s Failure to Disclose Information

On November 28, 2017, the Office of Inspector General (OIG) rescinded advisory opinion 06-04, in which it had previously determined that a charity’s (Requestor) proposal to provide assistance to financially needy Medicare...more

OIG Rescinds Advisory Opinion

by Holland & Knight LLP on

The Department of Health and Human Services Office of Inspector General (the OIG), on November 28, 2017, issued a Rescission Letter terminating Advisory Opinion Number 06-04 (Advisory Opinion 06-04). In Advisory Opinion...more

Another Obstacle to Medicare and Medicaid Compliance

by McGuireWoods LLP on

When investigating whether an individual or entity is excluded from the federal healthcare programs, healthcare organizations must be on the alert for yet another method for defrauding the government: alias names. Alias names...more

OIG: Medicare Program Integrity at the Top of HHS Management Challenges

by Reed Smith on

The OIG’s latest compilation of top HHS management and performance challenges flags vulnerabilities in key HHS health and social services programs, including includes the following: 1. Ensuring Program Integrity in...more

New OIG Project Expands Telemedicine Audits to State Medicaid Programs

by Foley & Lardner LLP on

Following on the heels of its plans to review Medicare payments for telehealth services, the federal Office of Inspector General (OIG) at the Department of Health & Human Services (HHS) just announced a new project to review...more

Blog: OIG Releases November Work Plan Items; Focus on Opioid Prescribing and Telemedicine

by Cooley LLP on

As we announced earlier this year, the Office of Inspector General (OIG) is updating its Work Plan monthly rather than its previous twice-yearly publications. The November updates include 4 new Work Plan items: - 1....more

Six Key Follow-Up Questions Asked by Congress in 340B Hearing

Earlier this month the House Energy and Commerce Committee’s subcommittee on Government Oversight and Investigations held its second hearing on the 340B Drug Discount Program. The hearing followed on the heels of a July 18th...more

OIG Wants CMS to Track Medicare Costs from Device Failures

by Reed Smith on

A recent Office of Inspector General (OIG) report suggests that the lack of medical device-specific information on Medicare claim forms complicates CMS efforts to identify and track Medicare costs related to the replacement...more

Blog: OIG Releases October Work Plan Items; Includes Opioid REMS and Specialty Drug Coverage and Medicare Reimbursement

by Cooley LLP on

As we recently announced, the Office of Inspector General (OIG) is updating its Work Plan monthly rather than its previous twice-yearly publications. The October updates include 5 new Work Plan items...more

OIG Finds Continued Procedural Errors in Hospital Outlier Payment Reconciliations

by Baker Ober Health Law on

The U.S. Department of Health and Human Services, Office of Inspector General (OIG) recently released a report concluding that there are vulnerabilities in the process of reconciling Medicare hospital outlier payments....more

OIG Finds Acute Care Hospitals Improperly Billed for Outpatient Services Provided to Inpatients of Other Hospitals

by Baker Ober Health Law on

Acute care hospitals that provide Medicare outpatient services to inpatients of other hospitals should be billing and collecting payment from the other inpatient hospitals and not from Medicare....more

HHS-OIG blesses product replacement program

by Dentons on

The federal health care program anti-kickback statute, 42 U.S.C. § 1320a-7b(b) (AKS), in addition to prohibiting payments for patient referrals, prohibits one party (such as a manufacturer) from providing anything of value to...more

OIG Report Finds Medicare Inappropriately Paid Hospitals for Certain Outpatient Services

by King & Spalding on

Last week, HHS OIG released a report finding that Medicare inappropriately paid acute-care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, such as long-term care hospitals,...more

OIG Approves (Yet) Another Medigap/PHO Arrangement in Advisory Opinion 17-04

by Baker Ober Health Law on

With Advisory Opinion 17-04, issued August 24, 2017, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) adds to the ever-growing number of favorable advisory opinions regarding an agreement...more

OIG Issues “Early Alert” on Potential Cases of SNF Abuse/Neglect

by Reed Smith on

The Office of Inspector General has issued an “early alert” warning that “CMS procedures are not adequate to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in [skilled nursing...more

OIG: “High-Performing” ACOs Point the Way for Medicare Shared Savings Program Savings

by Reed Smith on

The OIG has examined the results of the first three years of the Medicare Shared Savings Program, under which accountable care organizations (ACOs) coordinate care to reduce Medicare costs and improve quality of care. The OIG...more

OIG Advisory Opinion Allows Waiver of Cost Sharing in Research Studies

by Polsinelli on

Recently, the U.S. Department of Health and Human Services, Office of Inspector General (“OIG”) issued an Advisory Opinion (17-02) that allows for waivers or reductions of cost-sharing amounts owed by financially needy...more

Expanded Fraud and Abuse Liability under Proposed “Medicare for All” Bill

by Arnall Golden Gregory LLP on

On September 13, 2017, Senator Bernie Sanders (I-VT) introduced his “Medicare for All Act of 2017” which, as the name implies, would expand Medicare to cover nearly every American. Although it is unlikely that the bill will...more

Concierge Medicine – Medicare Compliance Is Still A Consideration

by Farrell Fritz, P.C. on

In our July 10, 2017 post, Concierge Medicine – Is it for you?, we cautioned that Medicare compliance concerns do not fall away when moving to a concierge or direct-pay model. HHS has determined that concierge-style...more

Blog: OIG Releases September Work Plan Items; Includes Part D Sponsor Reporting of Rebates and Price Concessions to Medicare

by Cooley LLP on

As we recently announced, the Office of Inspector General (OIG) is updating its Work Plan monthly rather than its previous twice-yearly publications. The September updates include 9 new Work Plan items: Federal Marketplace...more

Inspector General Audit Could Impact Skilled Nursing Facilities

by Ruder Ware on

Skilled nursing facilities (SNF) may see even more scrutiny from the Centers of Medicare and Medicaid Services (CMS) because of a recent audit conducted by the Office of Inspector General of the U.S. Department of Health and...more

OIG issues Advisory Opinion on a Retail Pharmacy’s Paid Membership Program Which Includes Federal Health Care Program...

by Dorsey & Whitney LLP on

On September 7, 2017, the OIG posted an advisory opinion regarding a retail pharmacy chain’s proposal to extend to federal health care program beneficiaries the option to participate in a paid membership program that includes...more

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