The Federal Government Adds an Additional $23 Million to New York State’s Medicaid Bill

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 Rise of the Worthless Services Theory in Federal False Claims Act (Whistleblower) Cases – A Look to the Future

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 […]

Who’s Looking Out for Patients? OIG Recommends more CMS Oversight of Medicaid Managed Care Programs

Office of the Inspector General of the federal Department of Health and Human Services (“OIG”) has issued a report that suggests that most states that offer Medicaid through Managed Care Organizations (“MCOs”) have widely-variable and possibly inadequate oversight of the organizations providing care to Medicaid beneficiaries.  Given OIG’s findings, beneficiaries, providers, and Medicaid MCOs should […]

Attention OMH Continuing Day Treatment Providers: OIG Releases Audit of CDT Programs, Seeks Repayment of over $18 Million to Federal Medicaid Program

The United States Department of Health and Human Services Office of the Inspector General (“OIG”) conducted an audit of New York State’s nonhospital-based Continuing Day Treatment (“CDT”) program.   CDT services are clinic services administered by the New York State Office of Mental Health (“OMH”). OMH’s CDT program provides Medicaid recipients with treatment designed to […]

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 […]

Medicare Payments for Zombies: OIG reveals that Medicare Advantage payments sometimes outlive beneficiaries

Just in time for Halloween, in a Medicare audit, the Office of the Inspector General of the Department of Health and Human Services has found that $23 million in Medicare expenditures in 2011 were paid inappropriately after the beneficiary had died.  The vast majority of these overpayments, 86 percent, flowed from Medicare Part C, also […]

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 […]

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 by selling or arranging for the sale of implantable medical devices. The United States Senate […]

New York State Allegedly Overbilled $15 Billion for State-Operated Facilities for Developmentally Disabled

On May 17, 2012, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) released a report that found Medicaid overpayments to New York State-operated developmental centers. The OIG concluded that, in 2009, State-operated  facilities for the developmentally disabled received $1.7 billion in Medicaid payments in excess of the reported costs of these facilities. […]