Aside from the United States Department of Health and Human Services Office of the Inspector General’s (OIG) Exclusion List for health care providers and entities, the Centers for Medicare and Medicaid Services (CMS) has recently established a new rule that created a Preclusion List for healthcare providers and entities as well. The new Preclusion List […]
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 […]
Last week, we highlighted that the Centers for Medicare and Medicaid Services (“CMS”) released a long-awaited final rule regarding its interpretation of the statutory obligation of Medicare Part A and Part B providers to return any overpayments they receive from the program within 60 days after such an overpayment is “identified.” The final rule is […]
After two investigations by the United States Department of Health and Human Services, Office for Civil Rights (“HHS”), St. Elizabeth’s Medical Center, a Boston-based hospital, has agreed to a Resolution Agreement with HHS. The Resolution Agreement appears to settle two apparently unrelated HIPAA issues at the same facility in 2012 and 2014.
The United States Department of Health and Human Services Office of Inspector General (“OIG”) issued a short Fraud Alert last week focusing on the anti-kickback implications of certain compensation paid to medical directors. OIG noted that it had recently settled with a dozen physicians who had entered into medical director positions of various health care […]
In 2011, the United States Department of Health and Human Services Office of the Inspector General (“HHS OIG”) investigated New York City’s Medicaid claims for continuous 24-hour personal care services, an area that previous HHS OIG audits consistently identified as one vulnerable to fraud, waste, and abuse.
As far as the Federal government is concerned, it appears that New York is running up quite a bill in claimed overpayments to its Medicaid program. After finding the State liable for nearly $1.26 billion in overpayments related to intermediate care facilities operated by the Office for People with Developmental Disabilities (“OPWDD”), the United States […]
The theory of “worthless services” has yet again been tried by whistleblowers in the federal False Claims Act context, this time resulting in a large settlement with the federal government. We saw this argument made previously in Ashber v. Momence, which we discussed in a prior article here. Now, Extendicare Health Services Inc., and its […]
New York State is appealing to the Secretary of the United States Department of Health and Human Services (“HHS”) for reconsideration of a July 25, 2014 Centers for Medicare and Medicaid Services (“CMS”) final audit report that found the State liable for $1,257,499,670 in federal Medicaid overpayments. In its letter to the State, CMS indicated […]
According to United States Attorney Richard S. Hartunian, the City of New York (NYC) has agreed to pay the United States Department of Justice (US DOJ) $1.05 million to settle allegations that the NYC Human Resources Administration (HRA) violated the federal False Claims Act by causing various managed care organizations (MCOs) to provide Medicaid coverage […]