OIG Okays Medigap Insurer’s Arrangement for Discount on Inpatient Deductibles

Last Monday the Office of Inspector General (OIG) of Health & Human Services posted an advisory opinion (No. 14-07) allowing a Medigap insurance company to strike a deal with hospitals for discounts—even waivers—of the deductibles owed by Medicare beneficiaries for inpatient stays.  The opinion indicates …

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AHA Renews Complaints about OIG Hospital Compliance Reviews

The American Hospital Association (AHA) has renewed its complaints about OIG “hospital compliance reviews.”  Last Thursday AHA Executive Vice President Rick Pollack sent a letter to Health & Human Services Secretary Burwell reminding her that in June he had written then Secretary Sebelius on the same …

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OIG Rejects Pharmacy’s Plan for Per-Fill Referral Fees, Or Be Careful What You Ask For

In its most recent advisory opinion, the Office of Inspector General (OIG) of Health & Human Services rejected a referral arrangement proposed by a national specialty pharmacy chain. Advisory Opinion No. 14-06, issued August 15, addressed a plan by the chain to reimburse local pharmacies for referrals of …

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Seventh Circuit Finds Worthless Services Case Worthless

Yesterday the Seventh Circuit issued an important decision on False Claims Act liability.  The decision arose out of a whistleblower complaint in the category known as “worthless services” lawsuits. Two nurses filed a whistleblower suit against the Illinois nursing home where they worked.  Their theory …

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August Scam-of-the-Month Award

The month is only two-thirds over, but it’s already clear who wins the August Scam-of-the-Month Award.  Cleveland Imaging & Surgical Hospital, in Cleveland, Texas, wins in a walk. It turns out that back in 2011 the hospital sold the right to use its hospital billing codes to free-standing clinics.  So …

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Research Doesn’t Pay—At Least Not in Graduate Medical Education

Monday the Seventh Circuit upheld the position of CMS that “pure research” by medical residents doesn’t count in the calculation of costs for graduate medical education reimbursement. Indirect graduate medical costs, or IGME, are what Medicare allows teaching hospitals in increased Medicare rates. IGME …

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