US HHS OIG and HCCA Release Compliance Program Effectiveness Resource Guide

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) and the Health Care Compliance Association (HCCA) released Measuring Compliance Program Effectiveness: A Resource Guide on March 27, 2017 (“the Guide”). The Guide was created by the HCCA-OIG Compliance Effectiveness Roundtable which convened in Washington, D.C., in January 2017 to explore ways to evaluate a corporate compliance program. 

Medicaid Program Integrity: US GAO Finds CMS Needs Work to Develop More Effective Oversight Efforts

On April 17, 2017, the United States Government Accountability Office (GAO) released a report about the current state of Medicaid program integrity. GAO conducted a study of the Medicaid program due to concerns about improper payments and was asked to conduct a study of the Centers for Medicare & Medicaid Services (CMS) to determine the […]

The OMIG Releases its 2017-2018 Work Plan

The New York State Office of the Medicaid Inspector General (“OMIG”) has released its annual Work Plan for fiscal year 2017-18.  The annual Work Plan offers providers insight into OMIG’s areas of focus in the New York State Medicaid program for the upcoming year.  As stated in the Work Plan, the OMIG’s overall mission “is […]

 CMS Announces RAC Audits To Begin in New York State

The Centers for Medicare and Medicaid Services (CMS) announced that Performant Recovery, Inc., New York’s Medicare Fee-for-Service Recovery Audit Contractor (RAC) for Region 1, can begin recovery audit activity now that provider outreach is complete. Region 1 includes the following groups of states:  J8, WPS: Michigan and Indiana; J15, CGS: Ohio and Kentucky; JK, NGS: New […]

ATTENTION OASAS PROVIDERS: JUSTICE CENTER INCIDENT REPORTING

Recently, the Counsel of OASAS, Robert Kent, sent a memorandum to all providers regarding Justice Center incident reporting policies and procedures for all OASAS providers. OASAS has also published a guidance document for incident reporting to the Justice Center under Part 836 of the OASAS regulations. Many OASAS providers have a process and procedure whereby […]

Governor Cuomo Announces Over $50 Million in Funding for Home Health Services for Senior Citizens Not Yet Eligible for Medicaid

Today, New York Governor Andrew Cuomo announced that $50 million in funding from the state’s Expanded In-Home Services for the Elderly Program has been awarded to the state’s county-based Area Agencies on Aging for the purpose of helping New York’s senior citizens to obtain home health care services.  The press release states that the funding “will […]

SCOTUS Decides Implied Certification Issue in Key False Claims Act (Whistleblower) Case

In a decision that is poised to have resonating implications for health services providers, the Supreme Court of the United States explicitly endorsed the “implied false certification theory of liability” under the False Claims Act (FCA) in Universal Health Services, Inc. v.  U.S. ex rel. Escobar.  Under this theory of liability, any person who submits […]

Are you a business that has had a data breach? Will your customers be able to sue you?

Class actions for damages resulting from a data breach are difficult to succeed upon unless there is an identifiable harm.  Once again a court has determined that the mere loss of data is not sufficient to confer standing (Chambliss v. CareFirst, Inc.,  No. RDB-15-2288 [D. MD., May 27, 2016]).  With the decision in Chambliss, Maryland […]