Tag Archives: Federal Law

Applicability of Fraud and Abuse Rules to the Marketplace Clarified … Somewhat

One of the lingering questions about the Health Insurance Marketplace created under the Affordable Care Act is whether plans on the Marketplace are considered part of a Federal health care program, thus opening up potential liability under the Anti-Kickback Statute. … Continue reading

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HIPAA Final Rule Posted

This afternoon, the Department of Health and Human Services posted a long-awaited, 563-page omnibus final rule under HIPAA, which will be published in the Federal Register on January 25, 2013, and which makes a variety of modifications to HIPAA’s Privacy, Security, Breach … Continue reading

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OIG finds DOH should refund nearly $8 million to federal government

In a recent audit of the New York State Department of Health (DOH), the Office of the Inspector General of the United States Department of Health and Human Services (OIG) found that several New York City area providers billed Medicaid … Continue reading

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United States HHS OIG Reviewing Self Disclosure Protocol for Federal Health Care Programs

The federal government’s Office of the Inspector General (“OIG”), part of the United States Department of Health and Human Services, is considering revising its self-disclosure protocol to provide additional guidance to federal health care program providers.  The OIG is soliciting … Continue reading

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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 … Continue reading

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Tax Dollars at Work: Federal Government Spent $102 million in Auditing Fees to Identify Less Than $20 Million in Medicaid Overpayments

The Government Accountability Office (“GAO”) has released a report following its review of the National Medicaid Audit Program.  The GAO has determined that this program, designed to fight Medicaid fraud, has cost the United States at least $102 million in auditing fees … Continue reading

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Ninth Circuit on HIPAA Criminal Liability: No Knowledge Requirement

On May 10, 2012, the United States Court of Appeals for the Ninth Circuit issued its opinion in United States v. Zhou, No. 10-50231 (9th Cir. May 10, 2012), and held that the criminal misdemeanor provision of the Health Insurance … Continue reading

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OIG Releases Report on Medicaid Rates for New York State-Operated Developmental Centers

The Office of Inspector General (“OIG”) released a report yesterday based on its review of the reimbursement rates for New York State-operated developmental centers.   The report found that the Medicaid daily rate for state-operated developmental centers was inflated, and that … Continue reading

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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, … Continue reading

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Supreme Court Upholds Applicability of Federal Arbitration Act to Predispute Nursing Home Arbitration Agreements

The use of arbitration clauses in nursing home admission agreements is a growing trend.  In some states, however, there is bias against the enforcement of such clauses, particularly those adopted prior to the occurrence of the events that give rise … Continue reading

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