Tag Archives: Fraud and Abuse

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 … Continue reading

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Fourth Circuit Decision Addresses Constitutionality of Per-Claim Penalty under Federal False Claims Act

The decision delivered just before Christmas by the United States Court of Appeals for the Fourth Circuit in US ex rel. Kurt Bunk, et al., v. Gosselin Worldwide Moving, N.V., et al. is of value and of interest to all healthcare … Continue reading

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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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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 … Continue reading

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OIG: PODs “Inherently Suspect”

On Tuesday, the federal Office of the Inspector General (“OIG”) issued a Special Fraud Alert (“Fraud Alert”) detailing the OIG’s concerns with Physician-Owned Entities.  Specifically, the alert dealt with physician-owned distributorships, or PODs.  PODs are typically entities that make money … Continue reading

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Auditing the Auditors, Part II: New York State Senate Republicans Request Independent Audit of the OMIG

As a result of a recent Congressional report on New York State’s Medicaid program, the Legislative Gazette has reported that Senate Republican leader Dean Skelos and New York State Senate’s Republican Conference have called for an independent audit of the … Continue reading

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Auditing the Auditors? Congressional Panel Requests Federal Audit of New York’s Medicaid Program

As a result of a recent Congressional report on New York State’s Medicaid program, a Congressional panel has requested that federal auditors review New York State’s $54 billion Medicaid spending and fraud, waste and abuse oversight programs. The report of … Continue reading

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OMIG Releases Annual Report for Calendar Year 2011

Today, the New York State Office of the Medicaid Inspector General (“OMIG”) posted its 2011 Annual Report.  We will post a detailed analysis in the coming days. In the meantime, the report may be accessed here.

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