Fraud Recoveries Grow as Feds Target Telemedicine and COVID-19 Add-On Test Scams

Despite the COVID-19 pandemic and continued sequestration of enforcement funds, the federal Health Care Fraud and Abuse Control Program (Program) reversed recent trends and recovered more money in FY … [Read more...]


OIG Work Plan Targets Medicare Part B Billing & Payment of Lab Tests

During the Public Health Emergency (PHE), the Department of Health and Human Services (HHS) has cut labs extraordinary slack in the form of waivers that temporarily loosen Medicare test coverage rules … [Read more...]


OIG Warns Medicare Beneficiaries Not to Fall for COVID-19 Scams

Pharma companies, diagnostics manufacturers, labs and other parts of the healthcare industry have done a commendable job in pivoting in response to the current public health industry. Sadly, scammers … [Read more...]

Enforcement Trends

COVID-19 Distractions Cause 2020 OIG Health Care Fraud Recoveries to Dip to 5-Year Low

Not surprisingly, the COVID-19 pandemic is hampering federal fraud fighting. The recoveries numbers bear this out. Here are the key findings from the OIG’s new Semi-Annual Report to Congress … [Read more...]

Compliance Alert

OIG Targets COVID-19 Test Labs for Potential Add-on Testing Abuses

Are labs taking advantage of the unprecedented demand for COVID-19 testing to bill Medicare for high reimbursing and medically unnecessary add-on tests? That’s what the OIG suspects and it plans to … [Read more...]

OIG Watch

Agency to Review First Two Years of PAMA-Based Medicare Reimbursements for Lab Tests

As we pass the midpoint of the third year of the PAMA experiment—if that’s what it is—the OIG announced plans to review what happened in years one and two. One of the new items on the agency’s Work … [Read more...]


HHS Puts Information Blocking and EHI Operability on Hold Due to COVID-19 Crisis

On March 9, 2020, the HHS Office of the National Coordinator for Health Information Technology (ONC) and CMS issued but didn’t publish final rules designed to improve patient access to their own … [Read more...]


OIG Temporarily Waives Anti-Kickback Restrictions for Certain COVID-19 Physician Arrangements

As it previously did with the Stark Law (See National Intelligence Report, NIR, March 25, 2020), the OIG is temporarily loosening Antikickback Statute (AKS) restrictions to clear the way for health … [Read more...]


Scorecard: OIG Enforcement Actions against Labs in 2019

Labs remain at the top of the OIG’s enforcement hit list, as illustrated by the number of cases involving labs cited in the agency’s new Semiannual Report to Congress for FY 2019: False Billing … [Read more...]


Kickbacks: OIG Withdrawal of Old Safe Harbor Proposals Clears Way for Meaningful Reform

Like the rest of the health care industry, labs need more not fewer new and modern Anti-Kickback Statute (AKS) safe harbors. So, the OIG's decision to cancel new safe harbors in incubation seems like … [Read more...]