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oig

Here at Last: OIG Allows Limited Risk Sharing for Hospitals and Manufacturers

[09/19/18]

Posted on September 19, 2018 in Health Law News

Published by: Hall Render

In the era of value-based care, health care providers and manufacturers are increasingly examining risk sharing opportunities in the treatment of patients. On September 17, the Department of Health and Human Services Office of Inspector General (“OIG”) published Advisory Opinion 18-10 whereby it approved a proposed risk sharing initiative with defined guardrails. The Advisory... READ MORE

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OIG Requests Information from Stakeholders to Expand Anti-Kickback Statute and Civil Monetary Penalty Safe Harbors

[09/14/18]

Posted on September 14, 2018 in Health Law News

Published by: Hall Render

On August 27, 2018, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) published a Request for Information (“RFI”) regarding the Anti-Kickback Statute (“AKS”) and Civil Monetary Penalties Law (“CMP”). The RFI, published as a result of HHS’s desire to transition the current health care system to one that pays... READ MORE

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OIG Approves of GPO Serving Wholly Owned Entities

[08/10/18]

Posted on August 10, 2018 in Health Law News

Published by: Hall Render

On August 6, 2018, the Department of Health and Human Services Office of Inspector General (“OIG”) published Advisory Opinion 18-07, approving an arrangement whereby a group purchasing organization (“GPO”) would serve as a purchasing agent on behalf of health care facilities under a common parent organization with the GPO (the “Proposed Arrangement”). This is... READ MORE

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OIG Approves Arrangement to Provide Free DME Samples

[06/06/18]

Posted on June 6, 2018 in Health Law News

Published by: Hall Render

On May 7, 2018, the Department of Health and Human Services Office of Inspector General (“OIG”) published Advisory Opinion 18-02, which approved an arrangement allowing a durable medical equipment (“DME”) distributor to provide patients with product samples at no cost to the patient. OIG stated that it would not impose sanctions against the parties... READ MORE

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Hyperbaric Oxygen Therapy Services: 2017 OIG Work Plan Initiative Finds 85 Percent of Claims Billed in Error

[04/26/18]

Posted on April 26, 2018 in Health Law News

Published by: Hall Render

On February 15, 2018, the Office of Inspector General (“OIG”) released a report announcing the results of a review it conducted of outpatient hyperbaric oxygen therapy (“HBO therapy”) claims. Of the 120 sampled outpatient claims under review, OIG found payment was made in accordance with Medicare requirements for only 18 claims. The audit, included... READ MORE

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OIG Final Rule Significantly Expands Exclusion Authority

[01/19/17]

Posted on January 19, 2017 in Health Law News

Published by: Hall Render

On January 12, 2017, the Department of Health and Human Services Office of Inspector General (“OIG”) published the “Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General’s Exclusion Authorities” Final Rule (“Final Rule”) revising and expanding its authority to exclude individuals and entities from participation in federal health care programs.... READ MORE

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CMS Comments on Compliance, QAPI Regulations

[03/22/13]

Posted on March 22, 2013 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

During yesterday’s Open Door Forum, Jeanette Kranacs, the Director of the Division of Institutional Post-Acute Care for the Centers for Medicare and Medicaid Services (“CMS”) commented that CMS will not be issuing instructions to surveyors on evaluating compliance and ethics programs until the regulations have been promulgated.  CMS was required to have final regulations and various tools in place as of... READ MORE

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OIG Issues New Guidelines for Review of State FCA Statutes

[03/15/13]

Posted on March 15, 2013 in False Claims Act Defense

Published by: Hall Render

The recent amendments to the False Claims Act, the Fraud Enforcement Recovery Act of 2009 (“FERA”), the Patient Protection and Affordable Care Act of 2010 (“PPACA”), and the Dodd-Frank Wall Street Reform and Consumer Protection Act (“Dodd-Frank”) continue to generate new rules and guidance. Effective 2007, Congress created incentives for States to pass and enforce mirror FCA statutes... READ MORE

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Deadline Looming for Nursing Facility Compliance Program Requirement

[02/06/13]

Posted on February 6, 2013 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

The Patient Protection and Affordable Care Act (PPACA) requires all skilled nursing facilities (SNFs) and nursing facilities (NFs) to have an effective compliance and ethics program in place by March 23, 2013.  Unfortunately, the Centers for Medicare & Medicaid Services (CMS) has failed to publish final regulations covering these programs, as required under PPACA, by... READ MORE

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OIG Publishes Findings of Nurse Aide Criminal History Investigation

[10/09/12]

Posted on October 9, 2012 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

As part of the Patient Protection and Affordable Care Act (PPACA), the Office of the Inspector General (OIG) was mandated to submit a report to Congress evaluating the Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long Term Care Facilities and Providers (commonly referred to as the “Background... READ MORE

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