NY Watchdog Releases Its Annual Fraud Fighting Plan

The New York State Office of the Medicaid Inspector General (OMIG or agency) has recently issued its 2017-2018 Workplan. The Workplan identifies key areas of OMIG’s focus impacting health care providers and suppliers.

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NJ’s Medicaid Watchdog Expands Audit and Exclusion Efforts

A recent report from the New Jersey Office of the State Comptroller indicates an expansion of the efforts of its Medicaid Fraud Division (MFD) to investigate fraud, waste and abuse in the New Jersey Medicaid Program. The report also highlights MFD’s expanded effort to exclude providers from the Medicaid Program.

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Beware of Inappropriate Physician Compensation Arrangements

“Physicians who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for bona fide services the physicians actually provide,” warns the new fraud alert published by the Office of Inspector General (OIG).

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A Look Back at NJ Medicaid Fraud Division Activities in 2014

The mission of the Medicaid Fraud Division (MFD) within the Office of the State Comptroller is to prevent, detect, audit and investigate fraud, waste and abuse by New Jersey providers and recipients. As we look forward to the New Jersey Medicaid Fraud Division 2015 work plan, we look back at the agency’s activities in 2014.

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NJSBA Health Law Section Event: Elements of Fraud and Abuse Investigation

Deniza Gertsberg, Esq. will be speaking during “Elements of Fraud and Abuse Investigation” presentation. The event focuses on the basics of a New Jersey Medicaid fraud and abuse investigation. The topics that will be discussed include responding to subpoenas, self disclosure and the use of statistical sampling in audits. The Deputy Director of New Jersey Medicaid Fraud Division, Mark Moskovits and former Director of the Medicaid Fraud Control Unit, Riza I. Dagli will also be presenting. Deniza Gertsberg, Esq. is one of the organizers of this New Jersey State Bar Association event which is open to all members of the NJSBA’s Health Law Section.

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OIG’s New Fraud Alert: Improper Payments From Labs to Docs

The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released a special fraud alert (Alert) in June concerning suspect arrangements between laboratories and physicians that raise Anti-Kickback statute (AKS) concerns.

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Inside Look At Healthcare Fraud Prevention Algorithms

On July 30, 2011, the Centers for Medicare & Medicaid (CMS) implemented its new Fraud Prevention System (FPS), which uses predictive analytics technology, similar to that utilized by credit card companies, to move away from the “pay and chase” model to instead detect aberrant or fraudulent billing patterns prior to payment of claims. According to CMS, by fiscal year 2013, CMS was able to take administrative action against 938 providers and suppliers using FPS, saving or preventing $210.7 million in payments.

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New Mandatory Security Requirements for NJ Prescription Scripts

In an effort to curb black market sale of prescription painkillers New Jersey is implementing changes to its paper prescription blanks. These changes represent the first change to the State’s prescription blanks since 2004.

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Fingerprint Requirement for DMEs and HHAs Goes Into Effect

The Centers for Medicare & Medicaid Services (CMS) announced that it will begin implementing the fingerprint-based background checks for providers and suppliers in certain risk categories.

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OMIG’s 2014-2015 Workplan

The New York State’s Office of the Medicaid Inspector General (OMIG) has released its program of activities for the current fiscal year. As in previous years, the agency’s audit and investigation function remain strong.

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OIG Recoveries and Exclusions Rise in 2011

Recently, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) calculated the savings its programs brought to the Federal government in 2011. The statistics, which reveal recoveries in the billions, serve as a sobering reminder to providers of the increasing interest by the government in ensuring that providers are complying with the healthcare laws and regulations.

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Basis for Medicare Exclusion

The Office of the Inspector General (OIG) within the Department of Health and Human Services (HHS) has broad authority to take measures such as excluding providers and suppliers from participating in the Medicare Program in order to protect the program and beneficiaries. There are a number of reasons why exclusions may be imposed and we summarize them below.

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Private and Government Health Plans Form New Anti-Fraud Alliance

On July 26, 2012, Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder announced an unprecedented partnership between private and public healthcare insurance organizations focused on fighting healthcare fraud.

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Health Care Fraud Prosecutions On The Rise

In the last few years, many healthcare providers have come under increased scrutiny from federal and state investigative and auditing agencies. The recent USAToday article confirms that the federal government stepped up the prosecution of health care fraud. In fact, according to USAToday “[n]ew government statistics show federal health care fraud prosecutions in the first

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7 Most Common Health Care Billing Abuses

At a recent Health Care Fraud Prevention and Enforcement Action Team presentation given by the Office of Inspector General (OIG), the agency stressed the importance of documentation and identified the following seven common billing abuses performed by providers.

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