The bill known as the “21st Century Cures,” H.R.6, would extend Civil Monetary Penalties (CMPs) to cover false claims and false statements relating to grants, contracts, and other agreements funded by the Department of Health & Human Services (HHS). Falsehoods relating to clinical trials appear to be a …
Attention Seniors! Check Into a Hospital and Get $100!
March 3, 2015 Leave a Comment
OIG Advisory Opinion 15-03 approves a Medigap insurer’s program that, among other things, calls for (a) network hospitals to waive the deductible for Medicare enrollees, (b) the insurer to pay the hospital network a fee each time it admits a Medicare enrollee, and (c) pay the Medicare enrollee $100 for being …
$85 MILLION SETTLEMENT WITH DOJ IN HALIFAX HOSPITAL STARK CASE
March 5, 2014 Leave a Comment
Facing as much as $1.1 billion in damages and civil penalties and having already spent more than $15 million in legal fees, Halifax Hospital in Daytona Florida averted jury selection in its upcoming trial by reaching an $85 million tentative settlement with the Department of Justice, according to the …
OIG Provides Insight Into New Self-Disclosure Protocol
June 4, 2013 Leave a Comment
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 …
The Wrinkle In Dinkel: The Departmental Appeals Board (Re)Defines the “Should Have Known” Standard for Exclusion Actions Under 1128(b)(7)
April 19, 2012 Leave a Comment
In a recent application of the Exclusion Statute, Social Security Act § 1128 et seq., the Department of Health & Human Services Departmental Appeals Board (Board) clarified that providers have an affirmative obligation to understand and correctly apply Medicare billing rules. In doing so, the Board arguably …
OIG Uses New Exception to Beneficiary Inducement Prohibition
January 28, 2011 Leave a Comment
In its first Advisory Opinion of 2011, the Office of Inspector General (OIG) used its discretion and applied the general standards of a new exception to the federal Civil Monetary Penalties (CMP) law when approving a hospital system’s program to waive copayments and deductibles and provide free lodging and …