Tag: Medicaid

HHS OIG Hands Out 2015 Work Plan For Halloween

On Friday October 31, 2014, the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) released its annual “Work Plan” for fiscal year 2015.  The Work Plan is a compilation of the OIG’s plans for new and ongoing reviews and activities (including audits, evaluations, and certain […]

Explosion of Big Data: What the Release of CMS Medicare and Sunshine Payment Data Means for Industry

The Centers for Medicare & Medicaid Services (CMS) released this month the 2012 Medicare payment data for individual physicians.  CMS also recently wrapped up its Phase I collection of data related to payments and transfers of value from pharmaceutical, medical device and biotechnology manufacturers and group purchasing organizations to physicians […]

OIG Report Shines Light on Vulnerabilities in EHRs

The U.S. Department of Health & Human Services Office of Inspector General (the “OIG”) recently released a report regarding how electronic health records (“EHRs”) may contribute to health care fraud, entitled “CMS and Its Contractors Have Adopted Few Program Integrity Practices to Address Vulnerabilities in EHRs” (the “Report”).  The Report describes […]

States Continue Medicaid Expansion Debate

As President Obama responds to healthcare.gov’s glitches, many states continue to debate whether to expand the Medicaid program in their respective states. The Supreme Court’s decision on the Affordable Care Act (“ACA”) allows states to opt out of the ACA’s Medicaid expansion provisions. Many states have stated their Medicaid expansion plans definitively; however, not all […]

CMS Releases New Information About State Medicaid Drug Utilization Review Practices

On July 30, 2013, the Centers for Medicare & Medicaid Services (“CMS”) posted state annual Medicaid DUR reports for fiscal year 2012.  States are required to complete annual Medicaid drug utilization review (“DUR”) surveys outlining prescribing habits, and describing cost savings generated from state Medicaid DUR programs and their Medicaid program’s […]