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Fraud and Abuse

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

We've featured some articles below, but be sure to check out all of our public policy and legal issues content.

 

Featured Content

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. Specifically, the proposed rule would add 3 new bases for exclusion called for under the Patient Protection and Affordable Care Act of 2010 (ACA). 

OIG Proposes Expanding Its Civil Monetary Penalty Authority

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) on May 12 issued a proposed rule that would expand its authority to impose civil monetary penalties (CMP) for a greater variety of violations. The rule seeks to implement Sections 6402(d)(2)(A)(iii) and 6408(a) of the Patient Protection and Affordable Care Act (ACA), which added 5 new violations and penalties to the existing CMP law. Comments to the proposed rule are due July 11.

OIG Issues Advisory Opinion No. 14-01 regarding Referrals to Senior Residential Communities

On Jan. 13, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued Advisory Opinion No. 14-01 in which it concluded that while an arrangement involving payments to a senior living placement agency would potentially generate prohibited remuneration under the Anti-Kickback Statue (AKS) if the requisite intent to induce or reward referrals of federal health care program business were present, parties to the arrangement had taken sufficient steps to adequately reduce that risk. As a result, OIG concluded that it would not subject the parties to administrative sanctions.

OIG Releases Revised Self-Disclosure Protocol

On April 17, 2013, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a substantially revised Self-Disclosure Protocol (SDP). This updated SDP supersedes and replaces the OIG's original 1998 SDP, as well as 3 Open Letters to Providers that the Inspector General issued about the SDP in 2006, 2008, and 2009. 

OIG Releases Video Podcast Regarding Board Role in Compliance Efforts

The board of a healthcare organization is critical to the organization’s compliance efforts, according to a new video toolkit from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG).