Tag Archives: OIG

New Regulatory Exceptions to the Beneficiary Inducement Statute

On January 6, 2017, several new regulatory exceptions to the beneficiary inducement statute went into effect. These regulations, published by the Department of Health and Human Services Office of Inspector General (OIG) in a final rule dated December 7, 2016,1 bring long awaited closure to many of the outstanding issues raised in the statutory versions … Continue Reading

OIG updates policy regarding gifts of nominal value

On Dec. 7, 2016, the U.S. Department of Health & Human Services Office of Inspector General (OIG) released an update to its 2000 policy regarding gifts of nominal value given to a Medicare or Medicaid beneficiary. The update increases the nominal value of gifts given to a Medicare or Medicaid beneficiary to $15 per occurrence … Continue Reading

OIG issues FY 2016 Work Plan with more than 40 new focal areas

The Office of the Inspector General (OIG) for the U.S. Department of Health & Human Services recently published its Fiscal Year 2016 Work Plan, which summarizes OIG’s priorities over the coming year. Notably, the 2016 Work Plan demonstrates the OIG’s expanded focus on delivery system reform and the effectiveness of alternate payment models, coordinated care … Continue Reading

OIG fraud alert regarding compensation agreements for physicians

The Office of Inspector General (OIG) for the U.S. Department of Health & Human Services (HHS) issued a fraud alert on June 9, 2015, targeting physician compensation agreements that potentially violate the federal Anti-Kickback Statute (42 U.S.C. § 1320a-7b). The Anti-Kickback Statute prohibits remuneration of payment in exchange for referrals of patients receiving aid from federally funded … Continue Reading

Physician compensation caution

The U.S. Department of Health & Human Services Office of Inspector General (OIG) issued a special fraud alert on June 9, 2015, stating that physician compensation arrangements may result in significant liability. Hopefully this is not a surprise to any physician or entity that treats federal health plan beneficiaries. However, given that, historically, OIG regulatory … Continue Reading

Compliance tips this week: Lessons learned from recent OIG enforcement actions

Based on OIG enforcement action excerpts for the past week, tips for staying ahead in healthcare regulatory compliance efforts include: Carefully review arrangements involving the receipt of cash in paper bags from service providers to which Medicare referrals are made. Also assess space rental and other arrangements with referral sources or destinations. www.justice.gov/usao/nj/Press/files/Onyenso,%20Chikezie%20Sentencing%20PR.html… Continue Reading

The OIG Advisory Opinion with the Fascinating Footnote

A recent OIG Advisory Opinion (Adv. Op. 13-15) is, to a certain degree, more interesting for one of its footnotes than the body of the opinion itself. The footnote addresses a hotly debated issue, originally raised in an OIG Management Advisory Report (MAR) in 1991. That MAR took the position that an agreement between a hospital … Continue Reading

Government Announces Record-Breaking Recoveries of Healthcare Fraud Money

The Departments of Justice and Health and Human Services released a report last week showing that the government has achieved the highest return on investment in the 16-year history of the Health Care Fraud and Abuse (HCFAC) Program.  According to the report, for every dollar spent on healthcare-related fraud and abuse investigations in the last three … Continue Reading

“Fiscal Cliff” Deal Extends Collection Time for Medicare Overpayments

President Barack Obama signed the American Taxpayer Relief Act of 2012, often called the “fiscal cliff” agreement, on January 2, 2013. Buried in the 59 pages of the act is a seven-line amendment to Section 1870 of the Social Security Act. This section bars recovery of overpayments from providers who are “without fault” and automatically … Continue Reading

OIG Projects $6.9 Billion in Recoveries From Audits and Investigations

In its Semi-Annual Report to Congress, OIG announced that expected recoveries for FY 2012 are $6.9 billion.  The $6.9 billion consists of $923.8 million in audit receivables and $6 billion in investigative receivables.  The investigative receivables include criminal restitution, settlements pursuant to False Claims Act (FCA) cases and Civil Monetary Penalty (CMP) actions, and other … Continue Reading

OIG Finds Hospital-Physician Call Coverage Arrangement Poses Little Risk Under Anti-Kickback Statute

The Office of Inspector General (OIG) of the Department of Health and Human Services has concluded that a per diem payment structure between a not-for-profit hospital and specialist physicians would not result in administrative sanctions under OIG’s civil monetary penalties law that relates to prohibited remuneration by the anti-kickback statute. According to an OIG Advisory … Continue Reading

What Should You Do When You Discover a Stark Violation?

Husch Blackwell attorneys David Pursell and Brian Bewley recently wrote an article for the Advisory Board regarding the Stark Law and self-disclosure.  In the article, they discuss what providers should do when they discover a Stark violation and the options for self-disclosure including disclosing to DOJ, OIG, and CMS.  To find out what the best option is … Continue Reading

Chief Counsel to OIG Says It Will Update Guidance for Entities

At a recent conference, Greg Demske, the new Chief Counsel to the OIG, said that his office will be issuing new guidance explaining how OIG will resolve cases where an entity hires or contracts with an excluded individual.  Given that the last guidance on this topic was issued in 1999, this should be a welcome … Continue Reading

Federal Government Threatens to Prosecute Providers Who Use Electronic Health Records to Commit Fraud

The heads of both the Department of Justice (DOJ) and Department of Health and Human Services (HHS) sent a joint letter on Monday, September 24, to five hospital industry groups, including the American Hospital Association, threatening to prosecute providers that use electronic health records (EHR) to “game” the system and improperly obtain federal monies for … Continue Reading

Home Health Billing Practices to Fix Now

In August, the Office of Inspector General (OIG) of the U. S. Department of Health and Human Services released a report describing inappropriate and questionable billing by home health agencies.  The OIG conducted the study because recent investigations and studies showed that home health agencies are vulnerable to fraud, abuse, and waste.  The OIG identified … Continue Reading