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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

Final Overpayment Rule Delayed by CMS Until 2016

In a Federal Register notice published on Feb. 17, the Centers for Medicare and Medicaid Services (CMS) announced that it would be delaying until Feb. 16, 2016, publication of a final rule governing the reporting and returning of Medicare overpayments.

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.

New Medicaid Documentation Toolkit Released by CMS

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. 

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.