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Articles by Lauren Gennett
OIG Releases Compliance Program Guidance Applicable to All Providers and Suppliers | JD Supra
On November 6, 2023, OIG released new General Compliance Program Guidance (General CPG). The General CPG applies to all individuals and entities involved in the healthcare industry.
Hospice Medical Director Sentencing Underscores Continued Hospice Enforcement Focus | JD Supra
In a press release dated September 27, 2023, the U.S. Attorney's Office in the Southern District of Texas announced that Jesus Virlar-Cadena was sentenced to serve 50 months in federal prison for his alleged role involving the submission of over $150 million in purported false claims to Medicare for hospice and other services. The court also ordered Virlar-Cadena to pay $9 million in restitution and $9 million in forfeiture.
CMS Review Choice Demonstration for Inpatient Rehabilitation Facility Services Beginning in August 2023 | JD Supra
On June 27, 2023, CMS hosted a Special Open Door Forum regarding its Review Choice Demonstration program for Inpatient Rehabilitation Facility Services (IRFs). CMS has stated that the Medicare IRF benefit continues to experience high levels of improper payments. The purpose of the Review Choice Demonstration is to establish a review choice process for IRFs to test for potential Medicare fraud and improve compliance with Medicare program requirements.
OIG Publishes the Spring 2023 Semiannual Report to Congress | JD Supra
OIG released its Semiannual Report to Congress (the Report) which summarizes the agency’s activities from October 1, 2022, through March 31, 2023 (the Reporting Period). Among other accomplishments, the Report highlights $892.3 million in expected recoveries as a result of HHS-OIG audits and investigations.
OIG Adds New Nationwide Inpatient Rehabilitation Facility Audit to Work Plan | JD Supra
This month, OIG updated its work plan to include a new Inpatient Rehabilitation Facility (IRF) Nationwide Audit. In explaining the new workstream, OIG cited high IRF error rates in other reviews and plans to determine whether Medicare IRF payment requirements require clarification. In the work plan entry, OIG states that in fiscal year 2021, Medicare paid approximately $8.7 billion for 373,000 IRF stays nationwide.
CMS Publishes Frequently Asked Questions Regarding Medicare Advantage Marketing Policies | JD Supra
CMS released an FAQ document regarding marketing and communications requirements for the Part C and Part D programs. The FAQs seek to clarify rules issued by CMS in the 2023 Medicare Advantage and Prescription Drug Benefit final rule that caused industry confusion.
DOJ and HHS Issue Healthcare Fraud and Abuse Control Program Fiscal Year 2021 Report | JD Supra
Last week, DOJ and HHS-OIG published its annual report regarding the Healthcare Fraud and Abuse Control (HFAC) Program (the Report). The Report summarizes the enforcement activity of DOJ and HHS and states that during Fiscal Year (FY) 2021, the Federal Government won or negotiated more than $5 billion in healthcare fraud judgments and settlements in addition to other healthcare administrative impositions in healthcare fraud proceedings.
OIG Publishes the Spring 2022 Semiannual Report to Congress | JD Supra
On June 6, 2022, OIG released its Semiannual Report to Congress (the Report) which summarizes the agency’s activities from October 1, 2021 through March 31, 2022 (the Reporting Period). Among other accomplishments, the Report highlights nearly $3 billion in expected recoveries as a result of HHS-OIG audits and investigations. In the Report, OIG also explains its continued focus on significant and high-risk issues in healthcare and its data analytics capabilities.
Massachusetts General Hospital Reaches Settlement to Resolve Overlapping Surgery Allegations | JD Supra
On February 18, 2022, Massachusetts General Hospital (MGH), the Massachusetts General Hospital’s Physician’s Organization, and Mass General Brigham Incorporated (collectively, Defendants) agreed to pay $14.6 million to resolve a False Claims Act lawsuit. The case included allegations Defendants billed government healthcare programs for certain overlapping surgeries that violated federal and state requirements.
OIG Issues Semiannual Report to Congress | JD Supra
In December 2021, OIG issued its Semiannual Report to Congress (SAR) covering OIG’s activities for the reporting period of April 1, 2021 through September 30, 2021, as well as the entire Fiscal Year (FY) 2021 (October 1, 2020 through September 30, 2021). The SAR projects that for FY 2021 approximately $787 million is expected be returned based on OIG audit findings and $3 billion is expected to be collected based on OIG investigative initiatives.
OIG Updates the Self-Disclosure Protocol | JD Supra
On November 8, 2021, OIG released an update to the Self-Disclosure Protocol (SDP). The revised SDP includes a name change for the SDP, increased minimum amounts required to settle under the SDP, a requirement that SDP submissions be made through OIG’s website, and additional clarifications. Fundamental elements of the SDP remain unchanged, such as submission timelines, submission content requirements, and approaches to damages calculations. The OIG first published the SDP in 1998.
OIG Issues Report Regarding Medicare Oversight of Cybersecurity for Networked Medical Devices in Hospitals | JD Supra
On June 21, 2021, OIG released a report titled “Medicare Lacks Consistent Oversight of Cybersecurity for Networked Medical Devices in Hospitals” (OEI-01-20-00220) (the OIG Report). OIG determined that CMS’s accreditation survey protocol does not include requirements for networked device cybersecurity, and Medicare Accreditation Organizations (AOs) do not employ their discretion to require hospitals to have cybersecurity plans.
HHS Amends PREP Act Declaration, Including Expansion of Telehealth for COVID-19 Countermeasures | JD Supra
On December 3, 2020, HHS issued its fourth amendment to the Declaration for Medical Countermeasures Against COVID-19 under the Public Readiness and Emergency Preparedness Act (PREP Act).
OIG Announces Resumption of Medicare Inpatient Short Stay Audits | JD Supra
In its November 2020 Work Plan update, OIG announced it will begin auditing short stay inpatient hospital claims under the Two Midnight Rule, and when appropriate, recommend overpayment collections. OIG does not specify the dates of service it plans to review, so it is possible that OIG could review short stay claims with dates of service prior to November 2020.
CMS Expands Prior Authorization Model for Non-Emergent Ambulance Transport | JD Supra
On September 22, 2020, CMS announced it will expand the Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) nationwide. The RSNAT Prior Authorization Model assesses whether prior authorization saves Medicare money while maintaining or improving the quality of care for repetitive, scheduled non-emergency ambulance transportation.
CMS Issues Proposed Rule That Would Update Home Health Payments and Allow Home Health Agencies to Continue Telemedicine Beyond Pandemic | JD Supra
On June 25, 2020, CMS issued a proposed rule that proposes routine updates to the home health payment rates for calendar year (CY) 2021 and includes a proposal to make permanent certain regulatory changes related to telehealth beyond the expiration of the public health emergency for the COVID-19 pandemic (the Proposed Rule).
HHS Announces New COVID-19 Testing Laboratory Data Reporting Guidance | JD Supra
On June 4, 2020, HHS released new guidance detailing what additional data laboratories must report to HHS along with COVID-19 test results. HHS explained that the new guidance standardizes reporting requirements in an effort to ensure that public health officials have timely access to comprehensive data to inform decision making related to COVID-19.
HHS Releases New Frequently Asked Questions Regarding CARES Act Provider Relief Funds | JD Supra
Last week, HHS released new and modified existing Frequently Asked Questions (FAQs) regarding payments distributed to providers via the CARES Act Provider Relief Fund. Importantly, the CARES Act requires that providers attest that they meet certain Terms and Conditions to retain Provider Relief Funds. The FAQs released by HHS provide additional detail regarding requirements for the Provider Relief Funds.
HHS Begins Delivery of Initial $30 Billion of Provider Relief Funding from CARES Act | JD Supra
Updated: May 25, 2018: JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations.
President Signs Coronavirus Spending Legislation that Includes Telehealth Expansion | JD Supra
Updated: May 25, 2018: JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations.
New York Hospital Settles Overlapping Urology Surgery Allegations | JD Supra
Updated: May 25, 2018: JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations.
OIG Releases Report Regarding Reasonable Assumptions in Manufacturer Reporting of Average Manufacturer Prices and Best Prices for Drugs | JD Supra
Updated: May 25, 2018: JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations.
District Court Dismisses Hospice False Claims Act Case Where Relator Failed to Identify False Records or Claims | JD Supra
Updated: May 25, 2018: JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations.
CMS Announces Settlement Program for Inpatient Rehabilitation Facility Appeals | JD Supra
Updated: May 25, 2018: JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations.
OIG Issues Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements Civil Monetary Penalty | JD Supra
JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations. This Privacy Policy describes how JD Supra, LLC ("JD Supra" or "we," "us," or "our") collects, uses and shares personal data collected from visitors to our website (located at www.jdsupra.com) (our "Website") who view only publicly-available content as well as subscribers to our services (such as our email digests or author tools)(our "Services").
Texas District Court Upholds Government Contractor’s Overpayment Extrapolation | JD Supra
JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations. This Privacy Policy describes how JD Supra, LLC ("JD Supra" or "we," "us," or "our") collects, uses and shares personal data collected from visitors to our website (located at www.jdsupra.com) (our "Website") who view only publicly-available content as well as subscribers to our services (such as our email digests or author tools)(our "Services").
Coalition of State Attorneys General Allowed to Intervene in Affordable Care Act Lawsuit | JD Supra
JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations. This Privacy Policy describes how JD Supra, LLC ("JD Supra" or "we," "us," or "our") collects, uses and shares personal data collected from visitors to our website (located at www.jdsupra.com) (our "Website") who view only publicly-available content as well as subscribers to our services (such as our email digests or author tools)(our "Services").
CMS Proposes Changes to Home Health Prospective Payment System | JD Supra
JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations. This Privacy Policy describes how JD Supra, LLC ("JD Supra" or "we," "us," or "our") collects, uses and shares personal data collected from visitors to our website (located at www.jdsupra.com) (our "Website") who view only publicly-available content as well as subscribers to our services (such as our email digests or author tools)(our "Services").
Fourth Circuit Affirms Dismissal of Antitrust Lawsuit Against Palmetto Health | JD Supra
JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations. This Privacy Policy describes how JD Supra, LLC ("JD Supra" or "we," "us," or "our") collects, uses and shares personal data collected from visitors to our website (located at www.jdsupra.com) (our "Website") who view only publicly-available content as well as subscribers to our services (such as our email digests or author tools)(our "Services").
CMS Proposes Changes to Inpatient Admission Orders in 2019 IPPS Proposed Rule | JD Supra
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Michigan Hospital Reaches Settlement with DOJ For Marketing Pact | JD Supra
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Lawsuit Filed by Kentucky Medicaid Beneficiaries Challenges Work Requirement Changes
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MedPAC Issues Report on Supervision Requirements in Critical Access Hospitals and Small Rural Hospitals
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Health and Human Services Solicits Suggestions for Precedential Medicare Appeals Council Decisions
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OIG Report Finds Medicare Inappropriately Paid Hospitals for Certain Outpatient Services
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CMS Announces Expansion of Targeted Probe and Educate Medical Review Strategy
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CMS Updates the Medicare Program Integrity Manual to Reflect Patient Status Reviews Under the Two Midnight Rule
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