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HHS OIG Release of New “General Compliance Program Guidance” Provides Valuable Insight on Prevention of Health Care Fraud, Waste, and Abuse

By Michelle E. Missigman, J.D.

On November 6, 2023, the U.S. Department of Health and Human Services (HHS), Office of the Inspector General (OIG), released 91 pages of “General Compliance Program Guidance” (GCPG) on its website. This is the first compliance program guidance the OIG has released since 2008. The GCPG provides general compliance guidance, tools, and references for use by federal health care program providers.

This new guidance brings together many resources and links, making it a valuable and easy-to-read tool to keep on hand for any professional working within the healthcare industry.

The GCPG covers the following topics:

I. Introduction

The GCPG provides a thorough introduction to the OIG’s history and commitment to preventing health care fraud an abuse. It provides a roadmap […]

By The Health Law Firm|2024-03-14T09:59:14-04:00January 4, 2024|Health Facilities Law Blog|

Ex-Navy Officer Sentenced to 2.5 Years in Prison For $2 Million Insurance Fraud

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On October 18, 2023, an ex-Navy officer was sentenced to 30 months in prison after he pleaded guilty to conspiracy to commit wire fraud for his role in an insurance fraud scheme. The judge tacked on an extra three years of post-release supervision.

The case is U.S. v. Cote et al., case number 3:18-cr-01674, in the U.S. District Court for the Southern District of California.

The Fraudulent Scheme.

The former Naval officer admitted to conspiring with eight others to defraud the Traumatic Service Members Group Life Insurance Program. This […]

By The Health Law Firm|2024-03-14T09:59:14-04:00January 2, 2024|Health Facilities Law Blog|

Steps to Take If You Receive an OIG Subpoena from the DOH

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The U.S. Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG). This agency investigates allegations of fraud, waste, and abuse against Medicare, Medicaid, and other federally funded healthcare programs. These subpoenas are very broad, usually requiring the production of thousands of pages of documents. Click here to see a sample of a subpoena duces tecum issued by the OIG.

Immediate Action to Take If the OIG Issues a Subpoena.

Immediately review the subpoena in detail to see what it requests and from whom. A subpoena […]

By The Health Law Firm|2024-03-14T09:59:15-04:00January 1, 2024|Health Facilities Law Blog|

AHCA Exemptions From Employment Disqualification for Florida Health Professionals

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Florida law requires that health professionals (including physicians, nurses, physical therapists, nurse practitioners, professional counselors, and social workers, among others) obtain a Level 2 background screening before working in a facility licensed by the Agency for Health Care Administration (AHCA). This includes third and fourth-year medical students, resident physicians, and nursing students. Often an arrest from years ago, sometimes decades ago, will be located during this screening. A letter stating that the individual is disqualified from employment or requiring an explanation may result. What do you do?

Level 2 […]

By The Health Law Firm|2024-03-14T09:59:16-04:00December 4, 2023|Health Facilities Law Blog|

New Study Faults Coding Structures For Increased Medical Billing Costs in U.S.

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A study publicized in August 2022 revealed that the complex coding structures used in the United States drive up medical billing costs. This helps to make the U.S. one of the most expensive countries for health providers to get paid. According to the study, researchers used a micro-level accounting of billing and insurance-related (often abbreviated “BIR”) expenses in different national settings at six provider locations in five nations: Australia, Canada, Germany, the Netherlands, and Singapore. This most recent study supplements a prior study measuring such costs in the U.S.

The findings, published […]

By The Health Law Firm|2024-03-14T09:59:16-04:00November 30, 2023|Health Facilities Law Blog|

Under Medical Peer Review from the Military or the Veterans Administration? Get Experienced Legal Representation Now

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Military physicians, Veterans Administration (VA) physicians, and former military and VA physicians often consult our firm concerning matters involving peer reviews of their care. In the military, whether Army, Navy, or Air Force, peer review for all physicians is governed by one general Department of Defense (DOD) Regulation. It is called the Defense Health Agency Procedures Manual (abbreviated DHA PM) 6025.13, which became effective October 1, 2019. VA physicians have different but somewhat similar regulations that apply to them.

We are often consulted by these physicians, who no longer even serve with those agencies […]

By The Health Law Firm|2024-03-14T09:59:16-04:00November 20, 2023|Health Facilities Law Blog|

Supreme Court Rules Against HHS in Hospital Medicare Reimbursement Case

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On June 15, 2022, the U.S. Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. This came in a ruling that limits regulators’ power to control what the program pays for certain drugs. In this case, the Supreme Court justices sided unanimously with a group of hospitals suing over drug reimbursement rates for facilities that serve low-income communities. In writing for the court, Justice Brett Kavanaugh said the U.S. Department of Health and Human Services (HHS) improperly calculated reimbursement rates […]

By The Health Law Firm|2024-03-14T09:59:16-04:00November 18, 2023|Health Facilities Law Blog|

Are You the Target of a Medicaid Audit? Tips Health Professionals Should Be Following

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Agency for Health Care Administration (AHCA), Office of Inspector General (OIG), and Bureau of Medicaid Program Integrity is the Florida agency responsible for routine Medicaid audits The agency ensures that the Medicaid program was billed correctly for services by health care professionals. Those receiving the greatest amounts of Medicaid payments are also the ones most likely to be audited.

These include pediatricians, Ob/Gyns, family practice physicians, and dentists. The Medicaid audit usually requests information in a questionnaire form. It also includes a request for […]

By The Health Law Firm|2024-03-14T09:59:17-04:00November 18, 2023|Health Facilities Law Blog|

Doctor’s Defamation Suit Against University over Use of Resident Physicians Moves Forward

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On July 11, 2023, the United States District Court for the Eastern District of Kentucky allowed a doctor to move forward with one of his defamation claims against the university’s provost for allegations made to support his termination.

A medical doctor and oral surgeon at the University of Kentucky (UK) sued the university and university officials on multiple grounds, including making a defamation claim against the university’s provost. The defamation claim stems from the Statement of Charges made by the provost in the physician’s termination proceedings.

The Statement […]

By The Health Law Firm|2024-03-14T09:59:17-04:00October 30, 2023|Health Facilities Law Blog|

DOJ Files False Claims Suit Against Nursing Homes Over “Substandard Services and Nonexistent” Care

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On June 15, 2022, the U.S. Department of Justice (DOJ) announced it has sued three nursing homes in Ohio and Pennsylvania, citing their “grossly substandard skilled nursing services.” The False Claims Act (FCA) complaint against the American Health Foundation (AHF), its affiliate AHF Management Corporation, and three nursing homes alleges the facilities fraudulently billed the Centers for Medicare & Medicaid Services (CMS) for often “nonexistent care.”

According to the complaint, all three AHF nursing homes not only provided substandard nursing home care services that failed to meet required standards of care but also did not maintain adequate […]

By The Health Law Firm|2024-03-14T09:59:18-04:00October 5, 2023|Health Facilities Law Blog|