Author Archives: Daniel J. O'Brien

OIG Publishes Special Fraud Alert regarding Physician-Owned Distributors (“PODs”) – Describes PODs as “Inherently Suspect”

Posted on April 16, 2013 | Comments Off

Over the last several years, there has been a noted proliferation in the growth of physician-owned distributors (“PODs”). Along with this growth has come increased scrutiny and speculation as to the legality of PODs, with highly vocal critics and proponents on both sides of the debate. In fact, the Office of the Inspector General’s (“OIG”) 2013 Work Plan noted that the OIG planned to examine PODs in connection with reports of high utilization of spinal implants by hospitals associated with PODs.

Accordingly, on March 26, 2013, the OIG released a Special Fraud Alert (the “Fraud Alert”) which provides long-awaited guidance concerning the legality of PODs. Continue reading →

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Posted in Anti-Kickback, DHHS, Fraud and Abuse, Health Care, Health Care Providers, OIG, Out-Patient Care, Physicians, Primary Care, Program Integrity, Regulatory Compliance, Special Fraud Alert, Supplier

OIG: Skilled Nursing Activities in the 2013 Work Plan

Posted on November 5, 2012 | Comments Off

On October 2, 2012, The U.S. Department of Health and Human Services Office of the Inspector General (“OIG”) released its Work Plan for 2013. The OIG releases its work plan for each year in advance of the coming year. The work plan provides stakeholders in the health care industry with a broad overview of the OIG’s activities in the coming year as they relate to its enforcement priorities and issues it will review and evaluate during that fiscal year. This client alert is the second in a series of alerts that will outline the OIG’s activities, as discussed in the 2013 Work Plan, for a specific industry sector – Nursing Homes.

The OIG’s activities relating to Nursing Homes for 2013 are focused on quality of care, although investigations concerning questionable billing patterns are once again identified as a priority. Continue reading →

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Posted in Compliance Programs, Fraud and Abuse, Health Care Providers, Medicaid, Medicare, Nursing Facility, Nursing Home, OIG, OIG Work Plans, Regulatory Compliance, Skilled Nursing Facility

New York Implements Federal Requirements Suspending Medicaid Payments for “Credible Allegations of Fraud”

Posted on September 6, 2012 | Comments Off

Under Section 6402 of the Affordable Care Act, State Medicaid programs are required to suspend all Medicaid payments to providers under investigation for a “credible allegation of fraud”. After more than a year of delay and discussion, on August 22, New York adopted regulations implementing this requirement, joining a number of other states who have already done so. Prior to enactment of the new regulations in New York, the decision on whether to withhold payments was discretionary. Continue reading →

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Posted in Fraud and Abuse, Health Care, Health Care Providers, Health Reform, Medicaid, New York, Regulation, Regulatory Compliance

Medicare Physician Fee Schedule – CY 2013 Proposed Rule

Posted on July 18, 2012 | Comments Off

On July 6, 2012, CMS issued the CY 2013 Medicare physician fee schedule proposed rule.  The rule includes several key aspects discussed below, such as improvements in payment for primary care and cuts to payments for specialty care.  Continue reading →

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Posted in Health Care, Health Care Providers, Medicare, Physicians, Primary Care, Proposed Rule, Regulation, Reimbursement