Fraud and Abuse

Our LeadingAge legal team offers analyses of regulations, case law and legislative developments regarding fraud and abuse issues.

 

  1. Final Overpayment Rule Delayed by CMS Until 2016

    The Centers for Medicare and Medicaid Services announced that it would be delaying until Feb. 16, 2016, publication of a final rule governing the reporting and returning of Medicare overpayments.   The rule is in response Section 6402(a) of the Affordable Care Act, which established a new section 1128J(d) of the Social ...

  2. New Medicare Provider Enrollment Regulation Now in Effect

    A final rule promulgated by the Centers for Medicare and Medicaid Services (CMS) that seeks to strengthen Medicare program integrity by restricting provider enrollment and facilitating provider revocation of billing privileges under certain circumstances became effective on Feb. 3, 2015. The final rule provides that enrollment ...

  3. New Medicaid Documentation Toolkit Released By CMS

    Included in the toolkit are a video presentation, study guide, and fact sheets Your Medical Documentation Matters (presentation)

  4. OIG Proposed Rule Would Expand Bases for Permissive Exclusions

    On May 9, the U.S Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a proposed rule that would expand the permissive bases upon which it can exclude an individual or entity from participation in federal health care programs.   Unlike those bases for exclusion that require ...

  5. OIG Proposes Expanding Its Civil Monetary Penalty Authority

    The Affordable Care Act of 2010 (ACA) expanded the OIG's authority to protect Federal health care programs from fraud and abuse. Via this Proposed Rule, the OIG would update its regulations to codify the changes made by ACA; make changes pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003; and ...