Office of Inspector General
OIG report finds that contractors are unable to identify overpayments due to flawed CMS database
Posted on February 21, 2012
A study released by the Department of Health and Human Services Office of the Inspector General (OIG) presents an early assessment of the efforts of Review Medicaid Integrity Contractors (Review MIC) to conduct data analysis to identify potential overpayments and provide or recommend audit leads to the Centers for Medicare & Medicaid Services (CMS). The objectives were: (1) to determine the extent to which Review MICs completed assignments, recommended audit leads, and identified potential fraud; and (2) to describe barriers that Review MICs encountered in their program integrity activities.
The OIG recommend that CMS…
CMS releases ACO final rule, others agencies weigh-in
Posted on October 20, 2011
The Centers for Medicare and Medicaid Services (CMS) released the much anticipated Accountable Care Organization (ACO) final rule, implementing section 3022 of the Affordable Care Act (ACA), which contains provisions relating to Medicare payments to providers of services and suppliers participating in ACOs under the Medicare Shared Savings Program. The rule on Medicare ACOs relaxes eligibility requirements for doctors and hospitals to participate by halving the number of performance measurements (65 to 33), removing the electronic medical records (EMR) requirement, and eliminating some financial risks. CMS also extended the deadline for ACO applications through 2012. As enticement to rural doctors and physician-owned practices, CMS said it would dedicate $170 million to said providers to start ACOs. Regulators estimate that between 50 and 270 ACOs will be established in the next 3 years, which will affect the care of 4% of Medicare beneficiaries.
Multiple federal agencies also released rules and guidance on fraud & abuse and antitrust issues related to ACOs. The HHS Office of Inspector General (OIG) issued an interim final rule (IFR) on the waiver of certain fraud and abuse provisions and the Department of Justice (DOJ) issued a statement on health care antitrust enforcement policies.
To read more about ACOs, click here.
For the ACO final rule fact sheet, click here.
Continue Reading "CMS releases ACO final rule, others agencies weigh-in" »
HHS Office of Inspector General’s Top Management and Performance Challenges for Fiscal Year 2010
Posted on March 18, 2011
The complexity and size of the U.S. health care system makes it susceptible to fraud and abuse in both the public and private insurance markets. According to the National Health Care Anti-Fraud Association (NHCAA), an estimated 3% of all health care spending is lost to fraud; government and law enforcement agencies have estimated fraud-related loses to be as high as 10% of annual health care expenditures. The financial ramifications of these fraudulent schemes are enormous to patients, providers and the federal government. Indeed, the U.S. Government Accountability Office (GAO) estimates that for 2010, Medicare alone had $48 billion in improper payments (underpayments and overpayments). In response to its findings, the GAO recommended that the Centers for Medicare and Medicaid Services find ways to address the vulnerabilities to improper payments and enhance program integrity.
Court allows Commonwealth suit to proceed
Posted on August 3, 2010
On Monday, Judge Henry Hudson of the United States District Court for the Eastern District of Virginia denied the Department of Health and Human Services’ motion to dismiss the case brought by the Commonwealth of Virginia alleging that the health reform law’s individual mandate is unconstitutional.
Continue Reading "Court allows Commonwealth suit to proceed" »
HHS files motion to dismiss Virginia health reform lawsuit
Posted on May 26, 2010
The Department of Health and Human Services has filed a motion in the District Court for the Eastern District of Virginia to dismiss the case brought by the Commonwealth of Virginia alleging that the health reform law’s individual mandate is unconstitutional.
Continue Reading "HHS files motion to dismiss Virginia health reform lawsuit" »
Stay Connected
Most Popular Content
- Contraception Coverage under the ACA’s Preventive Services Coverage Requirements, and Employer Implementation: An Update posted on April 20, 2012
- Update: Essential Health Benefits FAQs posted on May 9, 2012
- Update: Exchanges Establishment and Eligibility Final Rule posted on April 10, 2012
- State Health Insurance Exchange Navigators posted on February 28, 2011
- Update on the Final Rule: Standards Related to Reinsurance, Risk Corridors and Risk Adjustment posted on April 4, 2012
Categories
- Congressional Action
- Disparities
- Expert Commentary
- Fraud and Abuse
- Health Care Quality and Delivery System Reform
- Health Information
- Health Insurance
- Implementation Briefs
- Judiciary
- Key Developments
- Agency Profile
- Department of Education
- Department of Health and Human Services
- Administration for Children & Families
- Administration on Aging
- Agency for Healthcare Research & Quality
- and Public Health Council
- Centers for Disease Control & Prevention
- Centers for Medicare & Medicaid Services
- Health Promotion
- Health Resources & Services Administration
- National Institutes of Health
- National Prevention
- Office of Consumer Information and Insurance Oversight
- Office of Inspector General
- Office of Minority Health
- Office of Public Health and Science
- Office of the Secretary
- Department of Justice
- Department of Labor
- Department of the Treasury
- Grants
- Legislation
- Rulemaking, Rules, and Guidance
- Legal Challenges
- Long Term Care
- Medicaid and CHIP
- Medicare
- Public Health
- Tax Policy
- Workforce and Access
Archives by Date
- May 2012
- April 2012
- March 2012
- February 2012
- January 2012
- December 2011
- November 2011
- October 2011
- September 2011
- August 2011
- July 2011
- June 2011
- May 2011
- April 2011
- March 2011
- February 2011
- January 2011
- December 2010
- November 2010
- October 2010
- September 2010
- August 2010
- July 2010
- June 2010
- May 2010
- April 2010
- March 2010
Recent Posts
- Commonwealth Fund issue brief finds health insurance improves outcomes for vulnerable populations
- CCIIO announces potential plans for risk adjustment
- HHS publishes Exchange guidance and draft blueprint
- HHS releases web-based search tool to track health care system performance
- Heritage Foundation Recommends Eliminating Premium Subsidy for High Income Beneficiaries to Shore-Up Medicare
- Update: Medical Loss Ratio Requirements
- CMS releases final rule on MLR requirements
- Report estimates impact of small business tax credit
- Health Affairs article explores power of providers to win payment increases
- Department of Labor releases FAQs on mental health parity compliance
