HHS OIG 2010 Medicare Audit: $6.7 Billion Misspent for Evaluation and Management Services

The United States Department of Health and Human Services Office of the Inspector General (“OIG”) has completed its audit of 2010 Medicare payments for Evaluation and Management (“E/M”) services. The audit report, available at  https://oig.hhs.gov/oei/reports/oei-04-10-00181.asp, states that the Medicare program overpaid providers $6.7 billion for E/M services that were incorrectly coded or lacked documentation in […]

National Health Care Fraud Abuse Control Program Reports Record Recoveries and Return on Investment

Through their Health Care Fraud Abuse Control program (“HCFAC”), the United States Departments of Justice (“DOJ”) and the United States Department of Health and Human Services (“HHS”) have recovered more than $19 billion from health care providers over the last five years.  A report released on February 26 shows that the program’s three-year return on […]

Exclusion From Federal Health Care Programs: New Guidance From The United States HHS OIG

The United States Department of Health and Human Services Office of the Inspector General (OIG) has issued a Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs (“the Bulletin”).  The Bulletin replaces the previous OIG bulletin on this topic issued in 1999.  Exclusions from federal health care programs (including […]

Proposed Rule to Extend and Amend the Exception to Donate Electronic Health Records Items and Services

The Office of Inspector General for the Department of Health and Human Services (OIG) and the Centers for Medicare and Medicaid Services (CMS) published on April 10, 2013 proposed rules to extend and amend the Electronic Health Records (EHR) donation exceptions under the Anti-Kickback Statute and Stark Law, respectively. The proposed rules would extend the […]

Brooklyn DA Creates New Healthcare Fraud Division

On Monday, Kings County District Attorney Charles J. Hynes announced the creation of a new Healthcare Fraud division within his office.  The 30-person team, headed by ADA Lauren Mack, will collaborate with federal authorities, including the United States Department of Health and Human Services Office of the Inspector General and the United States Attorney for the Eastern […]

Ninth Circuit Court Rules Recovery Audit Contractor’s Decisions to Reopen Medicare Claims For Good Cause Can’t Be Challenged

Two weeks ago the U.S. 9th Circuit Court of Appeals ruled in Palomar Medical Center v. Sebelius that a health care provider is not entitled to challenge the determination of a Medicaid Recovery Audit Contractor (“RAC”) to reopen a Medicare claim for reimbursement for good cause. Palomar had provided inpatient rehabilitation services to a patient following […]

OMIG Adopts Regulations Concerning Withholding of Medicaid Payments When Fraud Is Alleged

In accordance with federal law, the OMIG has finalized proposed regulatory changes to conform New York State law to federal law regarding the withholding of payments to Medicaid providers when there is a “credible allegation of fraud.” This requirement is imposed on States that participate in the Medicaid program as part of the the Affordable […]

Legal Hurdles Mount for Lab Corp and Quest

The U.S. Department of Justice (DOJ) and the Federal Trade Commission (FTC) recently released their Annual Report for Fiscal Year 2011 under the Hart-Scott-Rodino Antitrust Act. In brief, the Hart-Scott-Rodino Act allows the DOJ and FTC to block transactions believed to be harmful to competition and consumers. The Annual Report reviews the enforcement activities undertaken by these […]

HHS OIG Identifies $332 Million in Uncollected Medicare Overpayments

On Friday the Office of Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) made public a report which revealed that the Centers for Medicare and Medicaid Services (“CMS”) had failed to collect over $332 million in Medicare overpayments, for the 30-month period ending March 31, 2009. During that time, OIG had issued […]

OMIG 2012-2013 Work Plan: A Brief Overview

“Fighting Fraud.  Improving Integrity and Quality.  Saving Taxpayer Dollars.” This phrase appears on each page of the newly released New York State Office of the Medicaid Inspector General (OMIG) State Fiscal Year 2012-2013 Work Plan. On the Executive Summary page, the OMIG’s stated mission is to “enhance the integrity of the New York State Medicaid […]