The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC or Program) under the joint direction of the Attorney General and the Secretary of the Department of Health and...
The OIG Opines regarding Loaned Smartphones for Low Income Patient Access to Care
August 4, 2022
During the PHE, access to care was limited and social isolation was real. To increase access, the Centers for Medicare & Medicaid Services (“CMS”) through blanket waivers and state Medicaid programs temporarily expanded the scope of the telehealth services for...
The Lone Star State’s Commitment to Exclusion Screening
July 22, 2022
The Texas Office of the Inspector General for the state’s Health and Human Services agency recently published a reminder about the significance of exclusion screening. Texas, like many states, maintains a state exclusion list that should be checked regularly in...
DOJ False Claims Highlights in 2021 and What to Expect Ahead
July 8, 2022
Over the past 5 years, there has been a decreased in false claims recoveries by the DOJ. That trend was resoundingly reversed in fiscal year 2021. In a press announcement on February 1, 2022, the DOJ released the following figures...
Screening Volunteers Against Exclusion Lists – Things to Consider
June 30, 2022
Background In 2013, the OIG issued an updated revised bulletin regarding the effect of exclusion from participation in federal programs. As part of that bulletin, the OIG addressed a number of somewhat gray areas including whether volunteers should be screened...
Updates on Data Modernization Efforts by the OIG
June 24, 2022
At the March 29, 2022 Health Care Compliance Association (HCCA) conference, Christi A. Grimm, HHS-OIG Inspector General, presented an update on key agency initiatives and priorities that directly impact health care and compliance communities. In April of 2021, Ms. Grimm...
COVID-RELATED FRAUD REMAINS A TOP LAW ENFORCEMENT PRIORITY
June 2, 2022
Even though COVID-19 seems to be receding in the minds of many, it continues to be the source of significant law enforcement actions at the federal level. COVID-related criminal investigations and prosecutions, from a fraud perspective, appear likely for the...
The OIG 2021 MFCU Performance Report Highlights
May 30, 2022
Background The function of state Medicaid Fraud Control Units (MFCUs) is to investigate and prosecute Medicaid provider fraud and patient abuse/neglect. The Social Security Act requires each state to operate a MFCU. MFCUs are funded jointly by federal and state...
Interested in Telehealth? So is the OIG!
May 18, 2022
Telehealth had been a small part of healthcare for many years, but the declaration of a Public Health Emergency (PHE) in 2020 accelerated both its use and scope when in-person healthcare services were simply not available. To meet the demand...
