News & Analysis as of

Office of the Inspector General

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

OIG Turns Its Attention to Telehealth Medicaid Compliance

by Baker Ober Health Law on

Telehealth providers participating in and receiving payment from Medicaid for telehealth services should take heed of the newly initiated items included in the OIG's November 2017 Work Plan update. (Beginning June 2017, the...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

States May Be Looking to Balance Budgets on the Backs of Medicaid Health Plan Reserves

by Alston & Bird on

As state governments look for ways to cover their budgetary shortfalls, Medicaid managed care organizations (MCOs) are an attractive target for cash-strapped states because many MCOs have accumulated “Medicaid savings”...more

Pursue Innovation or Maintain Eligibility? A Unique Faculty Model Could Cost an Institution $713 Million and its Future...

by Hogan Lovells on

Instructor. Regular. Substantive. Those three words, as defined by the U.S. Department of Education (“ED”) Office of Inspector General (“OIG”), resulted in OIG’s recent recommendation that Western Governors University (“WGU”)...more

Hospitals Will Need Psychiatrists And Mental Health Professionals To Satisfy EMTALA

by Cozen O'Connor on

Hospitals that have emergency departments should call upon their “available resources” to screen and stabilize patients with mental health emergencies as required by the Emergency Medical Treatment and Labor Act (“EMTALA”)...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

CMS Advisory Opinion 2017-01 Approves Pop-up Alerts to Physicians Through Online Laboratory Portal

by Baker Ober Health Law on

A clinical laboratory has received a green light from CMS to offer pop-up notifications alerting physicians of various potential issues (Laboratory Alerts) through its web-based portal for ordering and reporting results of...more

OIG Work Plan – October 2017 Update

by Baker Ober Health Law on

The OIG added five new items to its Work Plan with its October 2017 monthly update. This is a decrease from the nine new items added to the Work Plan with the September 2017 update. (For more information on last month's Work...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

The OIG issues dozens of new audit reports

by Ballard Spahr LLP on

Just in time for the end of the federal fiscal year (September 30), the HUD Office of Inspector General (OIG) issued a flurry of internal and external audit reports over the last few weeks on a wide variety of topics....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

Breaking Down the 2017 DOJ and OIG Compliance Guides

by McDermott Will & Emery on

Earlier this year, DOJ and OIG independently issued guides focused on evaluating compliance program effectiveness. The guides approach the topic from different perspectives but cover overlapping themes and work well in...more

Food & Beverage Litigation Update | October 2017

OIG Report Suggests Improvements to FSMA Enforcement - A report from the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services has concluded that the Food and Drug Administration (FDA)...more

Unintended Consequences: Ex-U.S. Activities Impacting U.S. Federal Health Care Business

by Ropes & Gray LLP on

Given the uptick in global awareness and enforcement of anti-bribery and corruption laws, most health care companies are attuned to the risks associated with legal infractions caused by ex-U.S. activities. However, ex-U.S....more

Value-Based Contracting for Prescription Drugs and Medical Devices: An Innovative Solution Impaired by Outdated Regulations

by Pepper Hamilton LLP on

Often lost in the cacophony of headlines surrounding rising health care costs is the promise that value-based contracting offers as a possible solution. In contrast to the traditional fee-for-service model, value-based...more

OIG report finds CFPB’s examination workpaper documentation practices can be improved

by Ballard Spahr LLP on

The Office of Inspector General (OIG) for the CFPB and Fed has issued a report that found the CFPB can improve its practices related to examination workpaper documentation. This report follows another OIG report issued last...more

Retail Pharmacy: OIG Signals It’s Okay to Reward Again

by Morgan Lewis on

OIG Advisory Opinion paves the way for expanded retailer reward programs. The US Department of Health and Human Services Office of Inspector General (OIG) issued an advisory opinion on September 7 that provides important...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 effectiveness of CFPB’s examiner commissioning and training programs could be improved

by Ballard Spahr LLP on

The Office of Inspector General (OIG) for the CFPB and Fed has issued a report on the results of its evaluation of the effectiveness of the CFPB’s Examiner Commissioning Program (ECP) and On-the-Job Training (OJT) programs. ...more

CFPB “Can Improve” Recordkeeping and Notifications of Purpose in Civil Investigative Demands, OIG Finds

by Ballard Spahr LLP on

On September 20, 2017, the Federal Reserve’s Office of Inspector General (“OIG”) issued a report on the CFPB’s process for issuing Civil Investigative Demands (“CID”). The OIG found that the CFPB “generally complied” with...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

In Targeting Outlier Payment Reconciliation, OIG Calls for an Aggressive Reading of CMS Reopening Regulations

by King & Spalding on

The HHS OIG recently published a report detailing CMS’s and Medicare Administrative Contractor’s (“MACs’”) ongoing issues in the outlier payment reconciliation process. A previous 2012 review identified 465 cost reports that...more

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