Tag: abuse

OIG Announces Updated Hotline for Reporting Fraud, Waste & Abuse

The Department of Health and Human Services (DHHS) Office of Inspector General (OIG) announced yesterday a revamped hotline for reporting fraud, waste, abuse and mismanagement involving DHHS programs. Complaints investigated by the OIG include, among other things, false or fraudulent claims submitted to Medicare or Medicaid; kickbacks or inducements for […]

OIG Releases December Work Plan Items; Focus on Opioid Prescribing Continues

As we announced earlier this year, the Office of Inspector General (OIG) is updating its Work Plan monthly rather than its previous twice-yearly publications. The December updates include 6 new Work Plan items: Status Update on States’ Efforts on Medicaid-Provider Enrollment. OIG will follow-up on a previous review to determine the extent to […]

CMS Announces that Data Analytics has Prevented $820M in Improper Medicare Payments

As we discussed here, the government continues to improve its use of data analytics to identify and prevent fraud, waste, and abuse in the health care industry. This week, the Centers for Medicare & Medicaid Services (CMS) announced that its Fraud Prevention System (FPS) has identified and prevented $820 million in improper […]

OIG Announces New Special Litigation Team

The Office of Inspector General (OIG) announced this week that it will launch a special litigation team devoted solely to Civil Money Penalty (CMP) and Exclusion cases. The announcement was made by representatives of the Administrative and Civil Remedies Branch of the OIG in a presentation at the American Health Lawyer’s Association (AHLA) […]

OIG Reports Targeting Medicare Part D Fraud Issued on the Heels of National Medicare Fraud Sweep

The Health and Human Services (HHS) Office of Inspector General (OIG) released two reports yesterday related to Medicare Part D fraud. The OIG report, Ensuring the Integrity of Medicare Part D, “synthesizes numerous OIG reports that have identified weaknesses in Part D program integrity, and provides updates on Departmental efforts to address these […]

TREND WATCH: GOVERNMENT USE OF DATA ANALYTICS TO IDENTIFY HEALTH CARE FRAUD

Data analytics is not a new concept within the health care industry. However, as data analytics tools become more accessible, government interest in using data analytics to detect health care fraud continues to increase. Government investigators also have been vocal in informing the health care industry that this powerful tool […]

Subcommittee on Oversight and Investigations Holds “Medicare Program Integrity: Screening Out Errors, Fraud and Abuse” Hearing

On June 25, 2014, the U.S. House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing, “Medicare Program Integrity: Screening Out Errors, Fraud, and Abuse.” During the hearing, subcommittee members heard testimony from administration officials from the Centers for Medicare and Medicaid Services (“CMS”), the Office of Inspector […]