In April, the U.S. Department of Health & Human Services’ Office of Inspector General (OIG) released an updated Provider Self-Disclosure Protocol (SDP) (here). The revised SDP supersedes the original SDP issued in 1998 (here), and incorporates a series of open letters issued by OIG in 2006 (here), 2008 …
Center for Medicare & Medicaid Innovation
May 16, 2013 Leave a Comment
Healthcare providers and payers may be salivating today with the news that the Center for Medicare & Medicaid Innovation (CMMI) – created under the Affordable Care Act and funded at $10 billion – announced a new $1 billion funding opportunity for innovations with promise to improve healthcare outcomes and …
CMS Releases Sunshine Law Final Rule
February 1, 2013 Leave a Comment
As is customary in Washington, a major announcement was made late on a Friday afternoon. CMS issued the long-awaited, 15-months-overdue (see here) Final Rule implementing section 6002 of the Affordable Care Act, which added section 1128G to the Social Security Act, better known as the Sunshine Law. CMS is …
The RAC Wars – The Latest Shot
November 21, 2012 Leave a Comment
The latest shot in the war between hospitals and RACs has been fired. The American Hospital Association (AHA) and four hospital systems brought a lawsuit against the Department of Health and Human Services (HHS), alleging that the government’s recovery audit contractor (RAC) program improperly demands …
PPACA CO-OP Health Plans Receive Approval
October 19, 2012 Leave a Comment
Health care reform created a new federal program, the Consumer Operated and Oriented Plan (CO-OP) program, to foster the creation of qualified non-profit health insurance issuers to offer qualified health plans in the individual and small group markets in the states in which the issuers are licensed to offer such …
More Problems With ZPICs
September 25, 2012 Leave a Comment
A recent OEI report found troubling conflicts of interest and financial relationships among potential Zone Program Integrity Contractors (ZPICs) used by the Centers for Medicare & Medicaid Services (CMS) in their controversial new National Fraud Prevention Program. Medicare fraud costs the government an …