Final Rule Released to the OIGs Exclusion Authorities

On January 11, 2017, the Office of Inspector General (OIG) of the Department of Health and Human Services released a final rule that incorporates statutory changes, early reinstatement provisions, and policy changes, and clarifies existing regulatory provisions to the OIG’s authorities to exclude persons and entities from participating in Federal health care programs. The Affordable Care Act of 2010 expanded the OIG’s authority to exclude various individuals and entities from participation in Federal health care programs under section 1128 of the Social Security Act (Act). The changes in the final rule to the OIG’s authority were also based on the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which amended the OIG’s authority to waive certain exclusions under section 1128 of the Act.

A copy of the final rule is available at: http://go.usa.gov/x9Ugu

Written by: Clay J. Countryman

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CMS Releases Final Medicare Outpatient Observation Notice

The Centers for Medicare & Medicaid Services (“CMS”) posted the final approved version of the Medicare Outpatient Observation Notice (“MOON”) on the CMS Beneficiary Notices Initiative website on December 8, 2016.[1]  According to CMS, all hospitals and critical access hospitals (“CAHs”) are required to provide the MOON beginning no later than March 8, 2017. Continue reading

Clay Countryman and Alec Alexander to speak at MGMA-New Orleans Chapter Workshop

Clay J. Countryman and Alec Alexander will be speaking at a workshop hosted by the Medical Group Management Association’s New Orleans chapter on September 28, 2016. Mr. Countryman will present “HIPAA Phase 2 Audits: Are you ready?” and Mr. Alexander will present “Fraud and Abuse: Compliance for Physician Practices and Recent Hot Topics. The workshop will be located at the East Jefferson General Hospital Conference Center – Esplanade I in Metairie, Louisiana. For more information or to register, click here.

Countryman, Clay headshot        Alexander, Alec headshot
Clay Countryman                     Alec Alexander

OCR Phase 2 HIPAA Audits Have Begun: Are you Ready?

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) has started a second phase of audits for compliance with HIPAA Privacy, Security and Breach Notification Standards. The OCR has previously conducted an audit pilot phase and Phase 1 audits of HIPAA covered entities (i.e., healthcare providers, clearinghouses, and health plans). In this Phase 2 of the HIPAA audits, OCR will audit both covered entities and their business associates. Continue reading

OIG Releases Updated Guidance on IRO Independence and Objectivity for Performing Corporate Integrity Agreement Reviews

The U.S. Department of Health and Human Services Office of Inspector General (OIG) released today, August 24, 2016, an updated guidance on the OIG’s views on the applicable independence and objectivity standards for Independent Review Organizations (IROs) that perform reviews required under Corporate Integrity Agreements (CIAs), such as claims reviews and cost report reviews. The OIG has previously issued guidance in 2004 and 2010 to reflect updated standards and the additional types of IRO reviews included in CIAs. This OIG guidance released today is to reflect the 2011 revisions to the GAO accounting standards. Continue reading