Statutes and Regulations

Home Health Final Rule Extends Exclusion Screening Obligation: Failure to Screen Could Result in Termination from Medicare

By Paul Weidenfeld and Catalina Jandorf  The new Final Rule issued by CMS revising the conditions of participation for home health agencies (HHAs) requires that providers “must ensure” that agencies providing services under arrangement have not been excluded from Medicare, Medicaid or any other federal health care program.  Effective July 17, 2017, the rule also states […]

DOJ Announces $4.7B in FCA Recoveries: What Does It Mean?

DOJ Announces $4.7 billion in False Claims Act Recoveries By Paul Weidenfeld December 16, 2016 The “Third Best Year” in False Claims Act History? The Department of Justice announced earlier this week that FY 2016 was its third best year in “False Claims Act History” with recoveries of more than $4.7 billion in settlements and judgments. […]

DOJ Doubles Down on False Claims Act Penalties!

  By Robert W. Liles.  August 3, 2016.  The False Claims Act is the primary civil enforcement tool utilized by the federal government in its fight against fraud generally, and, in particular, Medicare and Medicaid Fraud.[1]  Already an extraordinarily useful statute forgovernment prosecutors both in termsof ease of use and in terms of the penalties and damages that may […]

Medicare Fraud Act of 2016 Expands OIG Exclusion Authority

  I. Closure of OIG Exclusion Loophole The U.S. Department of Health and Human Services, Office of Inspector General’s  (HHS/OIG)  exclusion authority may be expanded to exclude certain individuals with a prior interest in sanctioned entities. U.S. House of Representative Lois Frankel introduced a bill called “The Fighting Medicare Fraud Act of 2016” on May 17, 2016. This bill will close […]

OIG Issues Updated Criteria for Implementing Its Permissive Exclusion Authority

On April 18, 2016, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) issued updated criteria for assessing and evaluating the imposition of permissive exclusions under Section 1128(b)(7) of the Social Security Act. The update replaces the 1997 Federal Register notice and demonstrates the OIG’s ongoing interest in the implementation and enforcement […]

Medicare Exclusion Checks Will be Audited by OIG

By Paul Weidenfeld In October of 2015, the Department of Health and Human Services, Office of Inspector General (HHS/OIG) issued its “Work Plan: Fiscal Year 2016.” The purpose of the Work Plan is to summarize new and ongoing OIG reviews with respect to HHS-programs and operations. Notably, both Medicare Exclusion and Medicaid Exclusion issues will be covered […]

Gary Cantrell Testimony: Failures to Report Adverse Licensing Actions Leads to Gaps in the OIG-LEIE

HHS/OIG Deputy Inspector General Gary Cantrell testified earlier this year that States are failing to report all of the adverse actions taken by their Licensing Boards. He suggested that the “manner and time of the [reported] notices” are unreliable. Cantrell attributed these concerns to the “voluntary” nature of State reporting obligations.[1] I.  The Impact on Exclusion […]