For what may be the first time, the Office of Inspector General (OIG) at the Department of Health & Human Services (HHS) recently announced a new project to review Medicare payments for telehealth services. Accordingly, providers who bill the Medicare program for telehealth services may expect to have those claims reviewed to confirm the patient … Continue reading this entry
Tags: Health Care, Healthcare, Medicare, Medicare Part B, Office of Inspector General, OIG, OIG 2017 Work Plan, Telehealth, Telemedicine
The Centers for Medicare and Medicaid Services (CMS) has demonstrated that it will not hesitate to use one of its most crippling administrative enforcement tools—the revocation of Medicare billing privileges—against one of its largest suppliers, as is evident in its case against Arriva Medical, LLC. Medicare billing privileges may be revoked for any one (or … Continue reading this entry
Tags: Arriva Medical, Centers for Medicare & Medicaid Services, CMS, DAB, Department for Health and Human Services, Departmental Appeals Board, HHS, Medicaid, Medicare, Office of Inspector General, OIG
A new regulation issued by the Health Resources and Services Administration (“HRSA”) sets forth a process by which civil monetary penalties may be imposed on drug manufacturers that knowingly and intentionally charge 340B covered entities for covered outpatient drugs more than the statutory ceiling price. The regulation addresses the ceiling price calculation for drugs purchased … Continue reading this entry
Tags: 340B, Centers for Medicare & Medicaid Services, covered outpatient drugs, HRSA, Office of Inspector General
Hospitals and providers participating in physician-owned distributorships, or “PODs” may be at increased risk for government investigation or enforcement. A Senate Finance Committee (SFC) Report issued this month highlights the SFC’s concerns that certain POD structures may violate fraud and abuse statutes, including the Anti-Kickback Statute, Stark Law, as well as the Sunshine Act. According … Continue reading this entry
Tags: ambulatory services, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Hospitals, Office of Inspector General, physician-owned entities, PODs, SFC, Sunshine Act
The Centers for Medicare & Medicaid Services (“CMS”) recently issued a final rule implementing provisions of the Patient Protection and Affordable Care Act of 2010 (“ACA”) that pertain to Medicaid reimbursement for covered outpatient drugs (“CODs”) and the Medicaid drug rebate program (the “COD Rule”). The COD Rule both clarifies and creates a dramatic shift … Continue reading this entry
Tags: average manufacturer price (AMP), Centers for Medicare & Medicaid Services, covered outpatient drugs, Medicaid, Office of Inspector General, Patient Protection and Affordable Care Act
If 2015 was the year that brought telemedicine directly to consumers, 2016 will be the year of telemedicine and Accountable Care Organizations (ACOs). ACOs are expected to increase the use of telemedicine technologies as a way to improve patient quality, achieve greater cost savings, and meet Center for Medicare & Medicaid Services’ (CMS) patient threshold.… Continue reading this entry
Tags: ACOs, Centers for Medicare & Medicaid Services, Medicare, Medicare Shared Savings Program, Office of Inspector General, Providers
The 340B Program continues to be an area of focus from federal policymakers, and recent activity and publications indicate that 2016 could be a monumental year for the program. Below is a breakdown of the recent and upcoming key initiatives related to the 340B Program.… Continue reading this entry
Tags: 340B, Department of Health and Human Services, Health Resources and Services Administration, managed care organizations, Medicaid, Medicare, Office of Inspector General
Accountable Care Organizations (ACOs) can share costs of telehealth and remote patient monitoring services among their hospitals, providers/suppliers, and other ACO participants, according to federal regulations under the Medicare Shared Savings Program (MSSP) fraud and abuse waivers. In protecting these arrangements, CMS and OIG recognize how telehealth technologies and innovative care processes can help reduce … Continue reading this entry
Tags: ACOs, Centers for Medicare & Medicaid Services, Medicare Shared Savings Program, Office of Inspector General, Telehealth
The Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) of the Department of Health and Human Services just issued a final rule setting forth waivers of specified fraud and abuse laws applicable to the Medicare Shared Savings Program (MSSP). The final rule replaces the Interim Final Rule (IFC) with comment … Continue reading this entry
Tags: ACOs, Centers for Medicare & Medicaid Services, Gainsharing Civil Monetary Penalty Law, Medicare Shared Savings Program, Office of Inspector General
Legislation being drafted as part of a budget deal between members of Congress and the White House includes language that will significantly alter the future of hospital-based outpatient care. The “discussion draft” of the bipartisan budget agreement would exclude from Medicare’s outpatient hospital prospective payment system (“OPPS”) any new off-campus departments of a hospital, as … Continue reading this entry
Tags: Hospitals, Medicare, MEDPAC, Office of Inspector General, outpatient services
As required by a 2014 statute, CMS has issued proposed regulations (Proposed Rule) implementing new requirements for laboratory reporting of, and eventually basing Medicare payment on, rates for clinical laboratory services paid by private payers. When finalized, the rules will appear in 42 C.F.R. Part 414, primarily in Subpart G. Comments on the Proposed Rule … Continue reading this entry
Tags: Centers for Medicare & Medicaid Services, Medicare, Office of Inspector General
The Office of Inspector General at the U.S. Department of Health and Human Services (“HHS-OIG”) announced, on June 30, 2015 (during a health care conference), the creation of a new litigation team that will focus solely on levying fraud-based civil money penalties and excluding providers from Medicare and Medicaid for committing fraud. The point is to … Continue reading this entry
Tags: Department of Health and Human Services, Department of Justice, Medicaid, Medicare, Office of Inspector General
Recent audits by the Department of Health and Human Services Office of Inspector General (“OIG”) conclude that state survey agencies in a number of states and a leading national accrediting agency serving the home health and hospice industry failed to identify a significant number of deficiencies related to worker qualifications. Based on these findings, OIG … Continue reading this entry
Tags: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Home Health Care, Hospice, Office of Inspector General
It appears that the Office of Inspector General (“OIG”) now has physicians squarely in the crosshairs of one of its most powerful enforcement tools: the Anti-Kickback Statute (“AKS”). The AKS is a criminal statute with stiff penalties. It prohibits the offer or payment of anything of value with the intent to induce the referral of … Continue reading this entry
Tags: Medicaid, Medicare, Office of Inspector General, whistleblowers
The Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services (HHS) published a notice of proposed rulemaking impacting the 340B Drug Pricing Program (340B Program) on June 17, 2015. The proposed rulemaking, required under the Affordable Care Act, address 340B drug ceiling price calculations and penalties that may be imposed … Continue reading this entry
Tags: 340B, Department of Health and Human Services, Health Resource and Services Administration, Office of Inspector General, orphan drug rules, Patient Protection and Affordable Care Act
The Centers for Medicare and Medicaid Services (“CMS”) released, on May 26, 2015, the a far-ranging proposal for revising the Medicaid managed care regulations (“Proposed Rule”). The number of individuals enrolled in Medicaid managed care plans has increased to over 40 million. Federal Medicaid managed care regulations have not been substantially revised since they were issued … Continue reading this entry
Tags: 340B, Centers for Medicare & Medicaid Services, Government Accountability Office, managed care organizations, Medicaid, Office of Inspector General, Patient Protection and Affordable Care Act
The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2014 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCUs) (OEI-06-15-00010, April 2015). Although the MFCUs reported another strong year in civil recoveries, criminal recoveries were significantly lower than last year, when … Continue reading this entry
Tags: Department of Health and Human Services, Medicaid, MFCU, Obama, Office of Inspector General, Patient Protection and Affordable Care Act
The Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services (“DHHS”) released new compliance guidance for health care governing boards, attorneys, compliance officers and internal auditors on April 20, 2015. The guidance was developed in collaboration with the Association of Healthcare Internal Auditors, the American Health Lawyers Association, the Health Care … Continue reading this entry
Tags: Audits, Department of Health and Human Services, Office of Inspector General
After repeated public statements warning companies that might seek to stifle whistleblowers, the U.S. Securities and Exchange Commission (SEC) has brought its first enforcement action relating to language in confidentiality agreements that the SEC believes could impede whistleblowers from reporting potential violations of the securities laws. As discussed in more detail below, this action suggests … Continue reading this entry
Tags: False Claims Act, Office of Inspector General, Securities and Exchange Commission, whistleblowers
This post is the fourth in Foley’s blog series, “Realizing the Potential of Telemedicine in China,” meant to address top issues facing U.S. companies looking to enter the Chinese telemedicine market. As U.S.-based health care providers look to China for new telemedicine opportunities, it is important to know your China partners before signing the contract. It … Continue reading this entry
Tags: China, Foreign Corrupt Practices Act (FCPA), International, mHealth, Office of Inspector General, Telehealth
No one running an ambulance company ever planned to go to prison for doing his or her job. But that is a real possibility if the government knocks on the door, and the owner or manager is dishonest in his or her response to the inquiry. CMS contractors are increasing the number of audits they are performing … Continue reading this entry
Tags: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Department of Justice, EMS, Office of Inspector General
The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS) released its Semiannual Report to Congress (Report) last week summarizing health care fraud investigation activities for the second half of fiscal year 2014 and the full year’s achievements. OIG reported expected recoveries of over $4.9 billion for fiscal year … Continue reading this entry
Tags: Audits, Department of Health and Human Services, Medicaid, Medicare, Office of Inspector General, Patient Protection and Affordable Care Act, Post Acute Care
For the past several years, the Centers for Medicare and Medicaid Services (“CMS”) has incentivized hospitals and eligible professionals to adopt and make “meaningful use” of certified electronic health records (“EHR”) technology through the Medicare and Medicaid Meaningful Use programs. Since the inception of these programs, over $16.6 billion in Medicare incentive payments and $8.6 … Continue reading this entry
Tags: Audits, Centers for Medicare & Medicaid Services, Electronic Health Records, False Claims Act, Office of Inspector General
We get this question every year: will Medicare, Medicaid or other payors continue to recognize hospital-level facility fee reimbursement for hospital outpatient departments meeting the provider-based designation criteria at 42 C.F.R. 413.65? This year, there have been suggestive developments and a few data points to consider as you evaluate your operations:… Continue reading this entry
Tags: Centers for Medicare & Medicaid Services, Hospitals, Medicaid, Medicare, Office of Inspector General
Posted in Telemedicine & Digital Health
Posted in Fraud & Abuse
Posted in Anti-Kickback; Compliance; Fraud & Abuse; Stark
Posted in Regulatory Developments; Reimbursements
Posted in Regulatory Developments
Posted in Telemedicine & Digital Health
Posted in Regulatory Developments
Posted in Regulatory Developments; Reimbursements
Posted in Fraud & Abuse; Litigation
Posted in Anti-Kickback; Fraud & Abuse
Posted in Compliance
Posted in Litigation
Posted in Telemedicine & Digital Health
