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.
A new Toolkit for Medicaid Medical Documentation has been released by the Centers for Medicare and Medicaid Services (CMS) Center for Program Integrity to educate Medicaid medical providers and staff about the importance of medical record documentation.
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).
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.
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.
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.