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Medicare Fraud and Abuse: Request for Information on Anti-Kickback Statute

The Office of the Inspector General for the Health and Human Services Department has issued a Request for Information regarding the Federal Anti-Kickback Statute and Beneficiary Inducements Civil Monetary Penalties. This consultation seeks public input on potential updates and clarifications to existing fraud and abuse provisions.

HHS OIG Delays Effective Date of Rule Consistent With Moratorium

The Department of Health and Human Services Office of Inspector General (HHS OIG) has delayed the effective date of certain provisions within 42 CFR 1001.952(h) and (cc). This action aligns with a congressionally enacted moratorium, impacting specific healthcare arrangements.

Performance Standards for Medicaid Fraud Control Units

The Office of Inspector General (OIG) within the Department of Health and Human Services has issued final performance standards for Medicaid Fraud Control Units (MFCUs). These standards, effective upon publication, aim to enhance the effectiveness of MFCUs in combating Medicaid fraud, waste, and abuse.

HHS OIG Solicitation for Safe Harbors and Fraud Alerts

The Department of Health and Human Services Office of Inspector General (HHS OIG) is soliciting proposals for new and modified safe harbors and special fraud alerts under the Medicare fraud and abuse provisions. This action aims to update existing protections and identify new areas of concern for healthcare providers.

Health Care Programs: Fraud and Abuse Exclusion Authorities Revisions

The Office of Inspector General (OIG) at HHS has issued a proposed rule to revise its fraud and abuse exclusion authorities. This proposed rule aims to update the criteria and processes by which individuals and entities can be excluded from participating in Federal health care programs.

Medicaid Applied Behavior Analysis Audits for Children with Autism

The HHS Office of Inspector General announced a series of audits of Medicaid Applied Behavior Analysis (ABA) services for children with autism. These audits aim to determine if state Medicaid agencies' payments complied with federal and state requirements, following identification of questionable billing patterns.

Hospital Billing Requirements Review for Overpayment Risk

The Centers for Medicare and Medicaid Services (CMS) announced a review series focused on hospital billing requirements to identify overpayment risks. A completed project for Sarasota Memorial Hospital identified at least $12.1 million in Medicare overpayments due to non-compliance with billing requirements.

Medicare Advantage Risk-Adjustment Data - Documentation Review

The HHS OIG announced a series of projects to review documentation supporting diagnosis codes submitted by Medicare Advantage organizations to CMS. CMS estimates 9.5% of payments to MA organizations are improper due to unsupported diagnoses.

HHS OIG: Over $15 Million in Improper Medicare Payments for Non-Emergency Services

The HHS Office of Inspector General (OIG) reported that Medicare improperly paid physicians $922,524 and potentially $14.2 million to hospitals for services billed with emergency department procedure codes but rendered at non-emergency sites. The OIG recommends recovery of improper payments and improved claims processing controls.