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HHS-OIG Issues Favorable Advisory Opinion on Nursing Home Discounts for Medicare and Medicaid Beneficiaries Who Have Private Insurance

Posted on December 27, 2017, Medicare and Medicaid

On December 8, 2017, the Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG) issued Advisory Opinion 17-08, in which it concluded that certain arrangements for nursing home discounts do not violate the federal Anti-Kickback Statute (“AKS”) or Civil Monetary Penalties Law (“CMPL”). The advisory opinion analyzed a proposed arrangement […]

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OIG Issues Report on Enhancing the Tracking and Collection of Medicare Overpayments Identified by ZPICs and PSCs

Posted on October 26, 2017, Health Care Medicare and Medicaid

The U.S. Department of Health & Human Services Office of Inspector General (“OIG”) recently published a report entitled “Enhancements Needed in the Tracking and Collection of Medicare Overpayments Identified by ZPICs and PSCs.” Zone Program Integrity Contractors (“ZPICs”) and Program Safeguard Contractors (“PSCs”) are private companies with which the Center for Medicare & Medicaid Services […]

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OIG Issues Favorable Advisory Opinion Regarding a Hospital Waiving or Reducing Cost-Sharing Expenses to Medicare Beneficiaries Who Enroll in a Clinical Study

Posted on July 18, 2017, Health Care Medicare and Medicaid

On June 27, 2017, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) issued Advisory Opinion 17-02 (“AO 17-12”) concerning an unnamed hospital’s proposal to waive or reduce certain cost-sharing fees owed by Medicare beneficiaries who enroll as subjects in a clinical research study at the hospital’s outpatient center (the “Proposed […]

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Medicaid Fraud Control Units Report Nearly $2 Billion in Total Recoveries for FY 2016

Posted on March 13, 2017, Medicare and Medicaid

On March 6, 2017, the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) published data regarding the enforcement activities of Medicaid Fraud Control Units (“MFCUs”) across the country during fiscal year 2016. Forty-nine states (all but North Dakota) and the District of Columbia operate MFCUs, with the objective of investigating and […]

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FEDERAL COURT ORDERS (EVENTUAL) END TO MEDICARE APPEALS BACKLOG AND CMS RE-OPENS HOSPITAL APPEALS SETTLEMENT PROCESS

Posted on December 12, 2016, Medicare and Medicaid

On December 5, 2016, Judge James Roasberg of the United States District Court for the District of Columbia issued a decision ordering the U.S. Department of Health and Human Services (HHS) to eliminate its massive backlog of Medicare billing appeals within the next five years. The court’s decision in American Hospital Association et al. v. […]

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PER-CLAIM PENALTIES FOR FALSE CLAIMS ACT VIOLATIONS SET TO RISE

Posted on July 7, 2016, Health Care Medicare and Medicaid

Contained within the bipartisan budget deal passed by Congress on November 2, 2015, the Federal Civil Penalties Inflation Adjustment Improvements Act of 2015 (the “Improvements Act”) mandates that all federal agencies make inflation-based adjustments to all civil monetary penalties (“CMPs”) within their respective jurisdictions by August 1, 2016. On June 30, the Department of Justice […]

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CMS UPDATES SELF-REFERRAL DISCLOSURE PROTOCOL IN LIGHT OF THE 60-DAY RULE

Posted on July 7, 2016, Health Care Medicare and Medicaid

In March 2016, the Centers for Medicare and Medicaid Services (“CMS”) published a long-awaited final rule pertaining to the 60‐day rule, which requires Medicare providers to report and return Medicare overpayments to the government no later than sixty (60) days after identifying and quantifying such overpayments. That final rule states that “overpayments must be reported […]

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CMS Updates Self-Referral Disclosure Protocol In Light Of The 60-Day Rule

Posted on June 2, 2016, Health Care Medicare and Medicaid

In March 2016, the Centers for Medicare and Medicaid Services (“CMS”) published a long-awaited final rule pertaining to the 60‐day rule, which requires Medicare providers to report and return Medicare overpayments to the government no later than sixty (60) days after identifying and quantifying such overpayments. That final rule states that “overpayments must be reported […]

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