Category Archives: Fraud & Abuse

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Happy Thanksgiving!

The Health Care Law Today team is thankful for you, our readers and subscribers. Thank you all for reading, contributing to, and sharing our blog. We hope you have a safe and happy holiday. Have a great weekend!… Continue reading this entry

Medicare's Fraud Prevention System: CMS Issues Second-Year Report to Congress

The Small Business Jobs Act of 2010 (pertinent sections of which are codified at 42 U.S.C. Section 1320a-7m) directed the Centers for Medicare & Medicaid Services (CMS) to use predictive modeling and other analytics technologies to identify and prevent fraud, waste, and abuse in the Medicare fee-for-service program. The statute required CMS to implement a … Continue reading this entry

OIG's Proposed Rule to Expand Civil Monetary Penalties

The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) on May 12, 2014 published a proposed rule (Proposed Rule) that would implement the OIG’s expanded authority under the Affordable Care Act (ACA) to impose Civil Monetary Penalties (CMPs) on providers and suppliers for “false and fraudulent claims and other … Continue reading this entry

CMS's Focus on DMEPOS Fraud and Abuse Risks Continues

The focus by the Centers for Medicare & Medicaid Services (CMS) on Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) as an area rife with unnecessary utilization and a high improper payment rates continues. CMS on May 28, 2014 published in the Federal Register a proposed rule to greatly expand prior authorization reviews for certain … Continue reading this entry

New York Office of the Medicaid Inspector General Releases 2014-2015 Work Plan

The New York State Office of the Medicaid Inspector General (OMIG) is the New York State (NYS) Medicaid program’s “watchdog” agency. (Last year they recovered in excess of $851 million from providers and others.) It is one of the most prominent state OMIG’s in the country, so providers in other states keep an eye on what the … Continue reading this entry

Recent Decision Underscores Need for Involvement of Counsel in Internal Investigations

A recent federal court decision raises concerns about the ability of companies to maintain privilege over materials generated in connection with internal investigations. The case, United States ex rel. Barko v. Halliburton Company et al., No. 1:05-CV-1276 (D.D.C. Mar. 6, 2014), involved allegations by a qui tam relator that his employer committed abuses in connection … Continue reading this entry

CMS Releases Medicare Part B Supplier Billing and Payment Data

Potential for Increase in Whistleblower Litigation On April 8, 2014, The Centers for Medicare & Medicaid Services (CMS) released, with tremendous fanfare, hundreds of thousands of points of billing data regarding Medicare suppliers including some 880,000 physicians for 2012. These data are presented in an Excel format that makes searching and scanning easy. Within 48 … Continue reading this entry

OIG Releases Report on Medicaid Fraud Control Units

The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2013 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCU) (OEI-06-13-00340, March 2014). As part of their state Medicaid plans, all states must operate a MFCU or convince HHS that it is … Continue reading this entry

Florida's False Claims Act - Did You Know It Changed Last Year?

In June 2013, Florida’s legislature significantly amended Florida’s False Claims Act, Fla. Stat. §§ 68.081-68.092 (“FFCA”), effective July 1, 2013. Although these amendments have not received much publicity or commentary, they considerably expanded the FFCA’s scope, among other important changes. Persons potentially subject to the FFCA, including those who seek and receive payments from the … Continue reading this entry

Final Regulations to Extend the Stark Exception and Anti-Kickback Statute

The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services’ Office of Inspector General (OIG) finalized amendments to the Physician Self-Referral Law (Stark) and Anti-Kickback Statute regulations (the Regulations) on December 27, 2013, regarding the donation of electronic health records (EHR) systems. Among other important changes, CMS and the … Continue reading this entry