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Category Archives: Medicare

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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

More About OIG’s Intensive Hospital Audits — Required Reading

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

In a previous post, OIG Has New, Intensive Hospital Compliance Initiative, I described the 4- to 6-week onsite audits that the OIG’s Office of Audit Services has initiated at several hospitals across the country.  Several readers asked for more details, so here they are.  This is another example of required reading. . . . The… Continue Reading

OIG Has New, Intensive Hospital Compliance Initiative

By Frank Sheeder on Posted in Enforcement, Government Initiatives, Implantable Cardiac Devices, Medicare, OIG

I understand that the HHS-OIG has begun a new and intensive Hospital Compliance Initiative that is different from previous efforts.  It intends to audit a large number of hospitals across the country on 28 separate issues.  The OIG has developed a list of errors that it commonly sees through its audits, whistleblower cases, investigations and self-disclosures.  It has… Continue Reading