On Tuesday, September 20, 2016, CMS published a proposed rule in the Federal Register to bolster the current State Medicaid Fraud Control Units (MFCUs or Units). MFCUs investigate and prosecute Medicaid fraud, including provider fraud, patient abuse, and neglect in health care facilities. MFCUs operate in 49 States and the District of Columbia. The MFCUs, typically a part of the State Attorney General’s office, use teams of investigators, attorneys, and auditors; are single, identifiable entities; and must be separate and distinct from the State Medicaid agency. The OIG oversees the MFCUs, annually recertifies each MFCU, assesses each MFCU’s performance and compliance with Federal requirements, and administers a Federal grant award to fund a portion of each MFCU’s costs.
HHS announces near-doubling of civil penalties for numerous infractions
Last week, HHS, OIG, CMS, the Office of the Assistant Secretary for Financial Resources, and the Administration for Children and Families issued an interim final rule (the Rule) that adjusts maximum civil monetary penalties for inflation.
OIG finds ED drug-discount program would not trigger kickback sanctions
On June 27, 2016, the OIG posted Advisory Opinion No. 16-07 stating that an erectile dysfunction (ED) drug manufacturer would not face sanctions for a planned discount-card promotion for the drug.
OIG finds CMS deficient in monitoring compliance by hospitals with provider-based status requirements
On June 17, 2016, the Department of Health and Human Services’ Office of Inspector General (OIG) released a report entitled “CMS Is Taking Steps to Improve Oversight of Provider-Based Facilities, But Vulnerabilities Remain” (OEI-04-12-00380).
The OIG reviewed oversight by the
OIG reports gain in expected recoveries for fraud and abuse matters
On Tuesday, the OIG released its Semiannual Report to Congress, which stated that expected recoveries for fraud and abuse activities total $2.77 billion in the first half of fiscal year 2016. This represents a gain of almost $1 billion when compared to the first half of fiscal year 2015. The report, which covers the time period of October 1, 2015 through March 31, 2016, stated that the $2.77 billion consisted of approximately $554.7 million in expected recoveries from audits and roughly $2.22 billion in expected recoveries from government investigations. Some recoveries are expected as settlement amounts may have been agreed to in principle, but the parties are still working on the details of the settlement agreement.
CMS seeks feedback on standard form for SRDP submissions
CMS has asked for comments on a form for healthcare providers to disclose actual or potential violations of the federal self-referral (Stark) law. The proposed format includes a disclosure form, a physician-information form, and a financial-analysis worksheet.
As many providers
New OIG exclusion guidance places value on self-disclosure
The OIG has issued updated guidance on the agency’s exclusion authority, as announced by Inspector General Daniel Levinson at the HCCA’s 2016 Compliance Institute.
According to the new guidance, good-faith self-disclosures will place providers at the lower-risk end of the
Government healthcare fraud-and-abuse recovery drops to $2.4 billion in FY 2015
In a report released on February 26, 2016, the federal government announced that it recovered $2.4 billion through its Health Care Fraud and Abuse Control Program (HCFAC) during FY 2015. The $2.4 billion is almost $1 billion lower than the recovery of $3.3 billion in FY 2014. Over the last three years, the return on investment (ROI) for the HCFAC program is $6.10 returned for every $1.00 expended. Qui tam litigation accounted for $452 million of the recovery by the federal government.
CMS issues anticipated Medicare overpayments final rule; relaxes initial proposals
On February 11, 2016, CMS issued a final rule clarifying the requirement of § 1128J(d) of the Social Security Act (created by § 6402(d) of the Affordable Care Act) that health care providers must report and return overpayments within 60
Increased focus on data analysis by government agencies
At a recent DC Bar program called “The Use of Data by the OIG-DHHS and CMS/CPI in Medicare Program Integrity, Investigations and Compliance,” representatives from CMS and the OIG provided their perspectives on the evolving capabilities of government agencies to review and analyze large datasets related to the provision and reimbursement of healthcare services.