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Keeping you afloat amidst the rising sea of regulations

Here’s Your Chance! OIG Seeking Proposals From the Health Care Industry on New Anti-Kickback Statute Safe Harbors and Fraud Alerts

The Department of Health and Human Services Office of Inspector General (OIG) recently released a proposed rule soliciting recommendations for new Anti-Kickback Statute (AKS) safe harbors, modifications to existing safe harbors, and new OIG Special Fraud Alerts.

In A Must Read, New OIG Guidance Provides Practical Ways to Evaluate Compliance Program Effectiveness

The Department of Health and Human Services recently issued an important new compliance guide, called Measuring Compliance Program Effectiveness: A Resource Guide. The Guide is a combined effort of HHS’s Office of Inspector General and the Health Care Compliance Association and provides guidance on evaluating compliance program effectiveness based on the input of 40 compliance professionals and OIG staff.

Health Fraud Rule Withdrawal May Hurt Enforcement Efforts

Partner Linda Baumann was recently quoted in the Bloomberg BNA article, “Health Fraud Rule Withdrawal May Hurt Enforcement Efforts,” appearing in both the Health Care Daily Report and the Medicare Report. The article discusses how fraud enforcement efforts in the health care industry may be hindered by the Trump Administration’s delay of a program integrity final rule that would have strengthened the government’s ability to suspend or revoke provider enrollment in Medicare and Medicaid.

OIG 2017 Work Plan Lists New Enforcement Priorities

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently published its Work Plan for fiscal year 2017 (2017 Work Plan), which furnishes key guidance to providers and suppliers (collectively referred to here as “providers”) and others doing business in the health care industry on the agency’s enforcement priorities for the upcoming year.

Ensuring Compliance With CMS 60-Day Overpayment Rule

* The following alert was originally published in Health Law360. To read it on the Health Law360 website, click here.

Don't Have a Heart Attack...but Enforcement Scrutiny Increasing Against Some Cardiac Care Providers

* The following alert was originally published in California Healthcare News (CHN). To read it on the CHN website, click here.

CMS Proposes New Requirements for Stark Self-Disclosures

On May 6, 2016, CMS published in the Federal Register a request for comments on proposed revisions to the information to be collected pursuant to the CMS Voluntary Self-Referral (Stark) Disclosure Protocol (SRDP). The proposed revisions introduce a new SRDP submission form and update the requirements of the SRDP to reflect recent regulations that require providers to self-disclose overpayments going back up to six years, when appropriate.

Office of Inspector General Evaluates the Enhanced Enrollment Screening of Medicare Providers

In March 2012, the Centers for Medicare & Medicaid Services (CMS) enhanced its Medicare enrollment screening for new and existing enrollees to the Medicare program. Providers not meeting CMS’s enhanced enrollment screening risk denial, revocation, or deactivation of Medicare billing privileges.

Providers Take Note: What the New Stark Regulations Mean to You

The Centers for Medicare & Medicaid Services recently issued final regulations implementing the Stark Law as part of the Physician Fee Schedule for 2016. While many of the changes are intended to make it easier for providers to comply with the Stark Law’s complex requirements, that should not engender a false sense of security.

DOJ Attorneys Disclose Health Care Enforcement Trends for 2016

Federal prosecutors appearing at the American Conference Institute’s 16th Annual Forum on Fraud and Abuse in the Sales and Marketing of Medical Devices earlier this month outlined recent enforcement trends that should catch the attention of the health care industry. Companies that ignore the warnings and lessons stemming from these public comments do so at their own peril, especially with regard to the False Claims Act.