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 […]
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 […]
This month, the United States Department of Health and Human Services Office of the Inspector General (“HHS OIG”) released its audit report for Ulster County’s 24-hour personal care services program.
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 […]
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 […]
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 […]
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 […]
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 […]