Health Care Enforcement and Compliance Matters Prevention, Compliance, Advocacy

Category Archives: Medicare

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An Opportunity for the OIG and Providers

By Frank Sheeder on Posted in Administration, Enforcement, Government Initiatives, Medicaid, Medicare, OIG, Settlements

The HHS-OIG has published a Federal Register notice asking for comments to its 14 year-old Provider Self Disclosure Protocol.  This is a great opportunity for providers to make their voices heard.  We are thinking about making some comments.  Feel free to contact me if you are interested in participating. In my opinion, the Protocol is… Continue Reading

Do Not Pay: The Government’s Newest Tool

By Frank Sheeder on Posted in Administration, Government Initiatives, Medicaid, Medicare, RACs

In previous posts and presentations, I have emphasized the critical role that data prospecting will play in the government’s efforts to prevent health care fraud, waste and abuse.  Here’s further support for the proposition.   The Office of Management and Budget has created a new tool called Do Not Pay.   It is complemented by a… Continue Reading

End-of-Life-Care: Rife with Fraud or Quicksand for the Government?

By Frank Sheeder on Posted in Enforcement, False Claims Act, Government Initiatives, Medicare

This is insight from Carolyn McNiven, a partner in DLA Piper’s Health Care Enforcement and Compliance Practice. The government’s intervention in a whistleblower’s federal False Claims Act case in Alabama(United States ex. Rel Dawn Richardson et al v. Golden Gate Ancillary LLC et al., 09 cv 627, ND Ala.) – which was recently made public … Continue Reading

12 Enforcement and Compliance Predictions for 2012

By Frank Sheeder on Posted in Culture, DOJ, Enforcement, Government Initiatives, ICD, Implantable Cardiac Devices, Long Term Care, Medicaid, Medicare, OIG, Reform, Settlements

This has been an interesting year for the health care industry, and I believe the coming year will be even more exhilarating.  Here are my 12 enforcement and compliance predictions for 2012.  Please comment with yours.  We’ll see how we do. . . .   Regardless of what happens with the health care reform law, the current market forces… Continue Reading

A 10-Year Old’s View of Health Care Enforcement

By Frank Sheeder on Posted in DOJ, Enforcement, Fraud, Medicaid, Medicare, OIG, Reform

My Daughter’s Depiction of Health Care Enforcement — I Call it Enforcica  — One of the more challenging and rewarding aspects of being a health care attorney is taking a complex regulated environment and breaking it down in a way that is understandable, regardless of the audience.  In the compliance world, this means communicating the rules… Continue Reading

Some Interesting RAC Results

By Frank Sheeder on Posted in Medicare, RACs

CMS has released its report to Congress about RAC activities for FY 2010.   The results are a mixed bag.  Here are some highlights: There were $92.3 million in identified and corrected improper Medicare payments. $75 million were overpayments. The RACs returned $17 million in underpayments.  That’s 18% of the identified improper payments, which is much better than the… Continue Reading

HHS Redoubles its Data Prospecting Efforts

By Frank Sheeder on Posted in CMS, Enforcement, False Claims Act, Government Initiatives, ICD, Implantable Cardiac Devices, Medicare, OIG, Reform

In previous posts, I have mentioned the government’s “data prospecting” efforts, and highlighted the difference between “data mining” and “data prospecting.”  Mining is done when you already know where to dig.  Prospecting, which is what the government has been doing, involves finding out where to dig.  There’s a big difference, and the implications should not… Continue Reading

View the OIG HEAT Provider Compliance Training Webcast

By Frank Sheeder on Posted in Administration, Enforcement, False Claims Act, Fraud, Government Initiatives, Medicaid, Medicare, OIG, Reform

OIG has posted a webcast of its HEAT Provider Compliance Training.  It is 3 hours, 45 minutes long.  I will post a summary in the near future.  There is also an OIG HEAT Provider Compliance Training Website at which you can download the corresponding slides and related materials. Get Instant Updates by Email

OIG’s HEAT Provider Compliance Training

By Frank Sheeder on Posted in Administration, CMS, DOJ, Enforcement, False Claims Act, Fraud, Government Initiatives, Medicaid, Medicare, OIG, Stark Law

Since February 2011, members of the HHS Office of Inspector General (OIG) and their colleagues have been presenting HEAT Provider Compliance Training across the country.  The most recent training included a live webcast with slides.  The OIG has committed to posting a link to the webcast by the end of May.  In the meantime, the slides… Continue Reading