C&M Health Law

C&M Health Law

Analysis, commentary, and the latest developments in health care law and policy

Tag Archives: OIG

Hospitals Beware: Medicare Electronic Health Records Incentive Payments to Hospitals are in the OIG’s Crosshairs

Posted in Digital Health, EHR, Fraud, Waste & Abuse, Health IT
The Department of Health and Human Services, Office of the Inspector General (OIG), modified its Work Plan to announce that the agency will be conducting a nationwide audit of hospitals that participated in the Medicare Electronic Health Records (EHR) Incentive Program (also known as the Meaningful Use Program).  The OIG review is focusing on hospitals… Continue Reading

Blocking Access to Health Information May Violate HIPAA

Posted in Health IT, HIPAA & Privacy
The HHS Office of Civil Rights published a new FAQ response (OCR FAQ) detailing the agency’s position that generally information blocking will violate the HIPAA Privacy and Security Rules if it affects a covered entity’s access to its own protected health information (PHI) or its ability to respond to requests for access to PHI from… Continue Reading

OIG Updates Policy on Permissive Exclusions Based On Fraud and Kickbacks

Posted in Administrative Law, Fraud, Waste & Abuse, Medicare
The Office of the Inspector General of the Department of Health and Human Services (OIG) last week replaced a 20-year old policy statement, and issued guidance on the criteria the agency will use to evaluate whether to exclude certain individuals and entities from billing or “participation in” Federal health programs under its permissive exclusion authority.… Continue Reading

CMS Issues Comprehensive Care for Joint Replacement (CJR) Model Final Rule

Posted in Fraud, Waste & Abuse, Medicare
On November 16, 2016, CMS posted the final rule to implement the Comprehensive Care for Joint Replacement (CJR) model, which is a new Medicare payment model intended to hold acute care hospitals financially accountable for the quality and cost of a CJR episode of care and incentivize increased coordination of care among hospitals, physicians, and… Continue Reading

Health Information Blocking Leads to New Requirements and May Lead to Enforcement Actions

Posted in Fraud, Waste & Abuse, Health IT
The federal government has spent billions to promote adoption and “meaningful use” of health information technology (HIT). There is growing government interest in ensuring that HIT is used to support patient care, but doing so requires electronic exchange of information. Congress, the Department of Health and Human Services (HHS), and States have taken action to… Continue Reading

DOJ’s Memo on Individual Accountability Tears at the Corporate Veil

Posted in Fraud, Waste & Abuse, Litigation
The Department of Justice (DOJ) has further focused its sights on individual executives as responsible parties for corporate misconduct.  On September 9, 2015, Deputy Attorney General Sally Quillian Yates issued a strongly worded seven-page memorandum to all U.S. Attorneys and the Assistant Attorneys General of DOJ’s various divisions nationwide titled “Individual Accountability for Corporate Wrongdoing”… Continue Reading

FY 2014 HCFAC Report Shows Increasing DOJ and OIG Fraud-Fighting Efficiency

Posted in Fraud, Waste & Abuse
Every year, the Department of Justice (DOJ) and the Department of Health and Human Services Office of the Inspector General (OIG) report the results of their fraud prevention and recovery efforts to Congress.  As recounted in the recently released Health Care Fraud and Abuse Control Program (HCFAC) report, the overall amount recovered in FY 2014… Continue Reading

CMS & OIG Continue ACO Fraud and Abuse Waivers for Another Year

Posted in Fraud, Waste & Abuse, Health Care Reform & ACA
On October 16, 2014, the Centers for Medicare & Medicaid Services (“CMS”) and the Office of the Inspector General (“OIG”) announced the continuation of the Accountable Care Organization (“ACO”) fraud and abuse waivers for an additional year. The Affordable Care Act (“ACA”) authorized creation of the Shared Savings Program to facilitate development of ACOs in Medicare.… Continue Reading

OIG Issues Self-Disclosure Guidance for Contractors

Posted in Fraud, Waste & Abuse, Medicare
The Office of Inspector General, Department of Health and Human Services, has recently issued guidance for those of its contractors seeking to self-disclose reportable conduct under the Federal Acquisition Regulations (“FAR”). Under federal regulations governing relationships between the federal government and its contractors, any contractors with credible evidence of a potential violation of the False… Continue Reading

CMS, OIG Disagree on Fraud Program Effectiveness

Posted in Fraud, Waste & Abuse, Medicare
The Centers for Medicare & Medicaid Services (CMS) identified over $210 million in savings during the second year of implementation of its predictive analytics-based Fraud Prevention System (“FPS”), according to a June 2014 report released last week. CMS claimed that these “identified savings” reflected a return of $5 for every dollar spent on the program,… Continue Reading

OIG Recommends that CMS Step Up its Oversight of Clinical Laboratory Billing

Posted in Fraud, Waste & Abuse, Medicare
On June 25, 2014, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) issued a special fraud alert titled Laboratory Payments to Referring Physicians, identifying “specific vulnerabilities with Medicare payments for lab services that need to be addressed to more effectively safeguard the Medicare program.” In 2010, the Centers for Medicare… Continue Reading

OIG Terminates Prior Opinion on EHR Exchange Fee Structure

Posted in EHR, Fraud, Waste & Abuse
In issuing Advisory Opinion 14-03 (the “New Opinion”) in early April, OIG also took the highly unusual step of rescinding another advisory opinion issued in 2011, Opinion 11-18 (the “2011 Opinion”). Both opinions involve electronic health record (EHR) interfaces that facilitate physician referrals to outside providers and suppliers for ancillary services. As OIG continues to… Continue Reading

OIG Concerned by CMS’s Reimbursement Methodology for ESRD Drugs

Posted in Medicare
OIG again expressed concern that CMS’s reimbursement methodology for drugs used in administering dialysis to end-stage renal disease (ESRD) patients may not adequately reflect the acquisition costs of the drugs, according to a recent report by the Office of Inspector General’s Office of Evaluations and Inspections. Building upon concerns expressed in a 2010 report that… Continue Reading

OIG Issues Unfavorable Opinion on Proposed Offer of Equity Interest to GPO Members

Posted in Fraud, Waste & Abuse
In Advisory Opinion 13-09, the HHS-Office of Inspector General (OIG) determined that a company’s offer of equity to members of its subsidiary group purchasing organization (GPO), partially in exchange for certain commitments to purchase through the GPO, could constitute a violation of the federal anti-kickback statute, 42 U.S.C. § 1320a–7b(b) (the “AKS”). While Advisory Opinion 13-09… Continue Reading