OIG: CMS Overpaid Providers Millions in EHR Incentive Payments

The Department of Health and Human Services’ Office of Inspector General (OIG) recently released a report finding that the Centers for Medicare & Medicaid Services (CMS) overpaid some $729 million in Medicare electronic health record (EHR) incentive payments to eligible providers who did not comply with federal meaningful use requirements. In its report, the OIG […]

OIG Says Free Labeling of Test Tubes, Collection Containers Could Violate Anti-Kickback Laws

The Office of Inspector General (OIG) recently issued an advisory opinion suggesting that a laboratory’s proposal to label test tubes and specimen collection containers at no cost to dialysis facilities could constitute remuneration under the anti-kickback statute and result in potential sanctions. The opinion issued this month came at the request of an unnamed laboratory […]

Feds target healthcare fraud by looking for outliers

Last week, the U.S. Department of Justice announced the largest healthcare fraud takedown in its history. Approximately 300 defendants in 36 federal districts, including South Florida, were charged with engaging in fraudulent billings to the tune of more than $900 million. Charges included: conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering […]

OCR launches Phase 2 HIPAA Audits

The U.S. Department of Health and Human Services Office of Civil Rights has launched Phase 2 of its long-awaited HIPAA Audit Program. OCR has already begun sending out address verification letters, which will be followed by a questionnaire. The new round of privacy and security audits will focus on the business associates of healthcare providers, […]

Government recovers $1.9 billion in healthcare fraud judgments and settlements in FY 2015

A newly released report by the Health Care Fraud and Abuse Control Program (HCFAC) shows that the federal government won or negotiated more than $1.9 billion in healthcare fraud judgments and settlements in fiscal year 2015. As a result of these efforts, as well as those of preceding years, in fiscal year 2015, approximately $2.4 […]

How data mining is uncovering healthcare fraud

What does your data say about your healthcare practice? Does it show that you bill considerably more than your colleagues for certain types of procedures? What about your facility? Is it performing more of a particular procedure than nearby competitors? These days, healthcare fraud investigators increasingly rely on data to root out healthcare fraud. They […]

With the new year comes greater HIPAA oversight

HIPAA-regulated entities can expect 2016 to be the year of increased oversight. That’s when the Health and Human Services Department’s Office for Civil Rights (OCR) begins Phase II of its audit program. The program is expected to focus on common areas of noncompliance and will include HIPAA-covered entities as well as business associates. Phase 2 […]

Feds to increase exclusion and civil monetary penalty enforcement cases

When it comes to exclusion and civil monetary penalty cases, the federal government is preparing to take an even harder line than in the past. During the recent Health Care Compliance Association’s Healthcare Enforcement Compliance Institute, Gregory Demske, chief counsel at the Health and Human Services Office of Inspector General, told an audience his agency […]

OIG opinion: Free transportation doesn’t violate anti-kickback statute

The U.S. Department of Health and Human Services Office of Inspector General recently issued an opinion stating that a large healthcare system’s free van shuttle service for patients does not violate the federal anti-kickback statute. The statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce […]

OIG opinion: Free home health visits are not kickbacks

The U.S. Department of Health and Human Services Office of Inspector General recently issued an opinion that a home healthcare provider’s policy to offer free introductory visits to patients who have already chosen it as their provider does not violate the federal anti-kickback statute. In its request for an advisory opinion, the home healthcare provider […]