Skip to Content

Tag: Office of Inspector General (OIG)


News

HHS-OIG details latest fraud activities 

December 4, 2023HME News Staff

WASHINGTON – The HHS-OIG’s Fall 2023 Semiannual Report to Congress highlights more than $3.44 billion in expected recoveries resulting from audits and investigations conducted during fiscal year 2023.  In FY 2023, HHS-OIG reported 707 criminal enforcement actions against individuals and entities suspected of engaging in crimes targeting HHS programs and the people they serve. They also reported 746 civil actions, which include false claims and unjust-enrichment lawsuits filed...

Audit, Department of Health & Human Services (DHHS), Investigation, Medicare fraud, Office of Inspector General (OIG), Semiannual Report to Congress


Read Full Articlered right arrow icon

Also Noted

OIG warns of RPM scam 

November 27, 2023HME News Staff

WASHINGTON – The Office of Inspector General has posted a consumer alert about a fraud scheme involving monthly billing for remote patient monitoring. The OIG says unscrupulous companies are signing up Medicare beneficiaries for monitoring using medical devices like scales, glucose monitors, blood pressure cuffs, cardiac rhythm devices and other equipment, regardless of medical necessity. The agency says these companies are signing up bennies for these services in several ways, including phone...

consumer alert, Fraud, Office of Inspector General (OIG), Remote Patient Monitoring


Read Full Articlered right arrow icon

Also Noted

OIG questions HHA fall reporting 

September 11, 2023HME News Staff

WASHINGTON – Over half of the falls among Medicare home health patients hospitalized for falls with major injury were not reported on patient assessments by home health agencies (HHAs) as required, according to a new Office of Inspector General report. Due to this high rate of non-reporting, Care Compare may not provide accurate information about the incidence of these falls, the OIG says. Reporting on OASIS assessments was worse among younger home health patients (compared to older patients)...

Falls, Medicare, Office of Inspector General (OIG), Reporting


Read Full Articlered right arrow icon

Also Noted

Price substitution policy works, OIG says 

September 5, 2023HME News Staff

WASHINGTON – Medicare and its enrollees have saved $73.4 million since 2013, because of CMS’s price substitution policy for Part B covered drugs, according to an August issue brief from the Office of Inspector General. They could have realized an additional $889,000 in savings in 2021, if CMS expanded the price-substitution criteria, the OIG says. When Congress established average sales prices (ASPs) as the basis for reimbursement for Medicare Part B drugs, it also provided a mechanism...

Average Manufacturer Price (AMP), Average Sales Price (ASP), Medicare, Office of Inspector General (OIG), Price Substitution


Read Full Articlered right arrow icon

News

OIG: More oversight needed of Medicaid managed care

July 20, 2023HME News Staff

WASHINGTON – Some people enrolled in Medicaid managed care may not be receiving all of their medically necessary health care services, according to a new study from the Office of Inspector General.  There are three key factors causing concern, the OIG says: the high number and rates of denied prior authorization requests; the limited oversight of prior authorization denials in most states; and the limited access to external medical reviews.  What the OIG found  Overall,...

Managed Care, Medicaid, Office of Inspector General (OIG)


Read Full Articlered right arrow icon

Casey Hoyt

Specialty Providers

Viemed’s Casey Hoyt on win: ‘We had the confidence to fight’

January 27, 2023Theresa Flaherty, Managing Editor

LAFAYETTE, La. – Viemed Healthcare’s recent victory at the administrative law judge level of the Medicare appeals process is as much a win for the company as the HME industry, says CEO Casey Hoyt.  Earlier this month, an ALJ judge ruled in favor of Viemed, overturning all remaining disputed claims for non-invasive ventilation related to the findings of an Office of Inspector General report and ordering CMS to return 100% of the previously remitted funds to the company.  “DME...

Noninvasive ventilators, Office of Inspector General (OIG), Viemed Healthcare


Read Full Articlered right arrow icon

News

OIG calls out unimplemented recommendations 

December 19, 2022HME News Staff

WASHINGTON – The Office of Inspector General has published its annual “Top Unimplemented Recommendations: Solutions to Reduce Fraud, Waste and Abuse in HHS Programs” and DME makes more than one appearance.  This year, the OIG’s recommendations focus on the top 25 unimplemented recommendations that, in its view, would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and public health and safety if implemented.  Recommendations...

CMS, Medicare, Office of Inspector General (OIG)


Read Full Articlered right arrow icon

OIG report on catheters: ‘Where are they getting their information?’

Specialty Providers

OIG report on catheters: ‘Where are they getting their information?’

November 22, 2022Theresa Flaherty, Managing Editor

YARMOUTH, Maine – An Office of Inspector General report “understates” the actual cost of providing catheters, especially given the complexity of both Medicare’s documentation requirements and the needs of patients, say providers.  The report, released in September, found that Medicare payments for intermittent urinary catheters were 3.4 times supplier acquisition costs in fiscal year 2020 and recommended that CMS lower its reimbursement rates.  “I’d...

Aeroflow, Catheter, Chris Malcom, First source catheters, Mica Philips, Office of Inspector General (OIG), Report, Urology


Read Full Articlered right arrow icon

News

OIG questions Medicaid spending by managed care plans 

September 27, 2022HME News Staff

WASHINGTON – CMS has an opportunity to strengthen state oversight of reporting by Medicaid managed care plans on medical loss ratios (MLRs), according to a new report from the Office of Inspector General. States reported that most Medicaid managed care plans submitted MLR reports; however, the OIG found that 49% of the 495 MLR reports reviewed were incomplete. These incomplete MLR reports were missing at least one of seven numeric data elements that are essential to the MLR calculation....

Medicaid Managed Care, medical loss ratio, Office of Inspector General (OIG)


Read Full Articlered right arrow icon

News

OIG assesses telehealth risks, CQRC responds 

September 12, 2022HME News Staff

WASHINGTON – High-risk providers represent a small portion of all providers who billed for a telehealth service, but strong, targeted oversight of these services is still important, according to a new report from the Office of Inspector General.  The OIG identified 1,714 providers out of about 742,000 whose billing for telehealth services during the first year of the pandemic posed a high risk to Medicare, representing a total of $127.7 million in Medicare fee-for-service payments for...

Council for Quality Respiratory Care (CQRC), Office of Inspector General (OIG), Telehealth


Read Full Articlered right arrow icon