What is the Office of Inspector General (OIG)?
The Office of Inspector General (OIG) for the U.S. Department of Health & Human Services has created the educational materials to assist in teaching physicians about the Federal laws designed to protect the Medicare and Medicaid programs and program beneficiaries from fraud, waste, and abuse.
What does the OIG do for health care organizations?
The OIG has created several toolkits to help providers ensure they are in compliance with health care laws. HHS-OIG issues advisory opinions about the application of certain fraud and abuse enforcement authorities to the requesting party’s existing or proposed business arrangements.
What is OIG compliance and why does it matter?
To help healthcare providers such as hospitals and physicians comply with relevant Federal health care laws and regulations, OIG creates compliance resources, which are often tailored to particular providers.
What happens if I am excluded from the federal health care programs?
If you are excluded by OIG from participation in the Federal health care programs, then Medicare, Medicaid, and other Federal health care programs, such as TRICARE and the Veterans Health Administration, will not pay for items or services that you furnish, order, or prescribe.
What is the Medicare Anti-Kickback Statute?
The AKS is a criminal law that prohibits the knowing and willful payment of "remuneration" to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients).
What constitutes Medicare abuse?
What Is Medicare Abuse? Abuse describes practices that may directly or indirectly result in unnecessary costs to the Medicare Program. Abuse includes any practice that does not provide patients with medically necessary services or meet professionally recognized standards of care.
Which governmental agency is responsible for monitoring Medicare?
The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS).
What is stark and anti-kickback law?
The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid, and from entering into certain kinds of ...
What are the three examples Medicare uses to describe abuse?
Common types of abuse include: Billing for unnecessary services (services that are not medically necessary) Overcharging for services or supplies. Misusing billing codes to increase reimbursement.
What is the federal False Claim Act?
Whistleblower Protection Under the False Claims Act The federal False Claims Act protects employees who report a violation under the False Claims Act from discrimination, harassment, suspension or termination of employment as a result of reporting possible fraud.
What is a Medicare OIG audit?
Under this authority, OIG conducts audits of internal CMS activities, as well as activities performed by CMS grantees and contractors. These audits are intended to provide independent assessments of CMS programs and operations and to help promote economy and efficiency.
What is the federal agency responsible for administering benefits in Medicare or Medicaid?
The federal agency that oversees CMS, which administers programs for protecting the health of all Americans, including Medicare, the Marketplace, Medicaid, and the Children's Health Insurance Program (CHIP).
What is the US Department of Health and Human Services responsible for?
United StatesUnited States Department of Health and Human Services / JurisdictionThe mission of the U.S. Department of Health and Human Services (HHS) is to enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.
What 5 elements must exist for a Stark Law violation to occur?
In order for a relationship to implicate Stark, five basic elements must be present: (1) a physician must make (2) a referral for the furnishing of (3) designated health services payable by Medicare (4) to an entity (5) with which he/she (or an immediate family member) has a financial relationship.
What are the exceptions to the Stark Law?
For example, the following exceptions to the Stark Law require a written, signed agreement: office space and equipment rental, personal service arrangements, physician recruitment arrangements, group practice arrangements, and fair market value compensation arrangements. 42 C.F.R.
What is an illegal provider relationship?
The Stark law prohibits a physician with a financial relationship in an entity from making a referral for designated health services covered by Medicare and Medicaid to that entity even if the services are billed to an individual or other third party payer.
When did the DOJ survey law enforcement?
The DOJ OIG surveyed law enforcement personnel within the DOJ during July and early August of 2020 to gain insights on the effect and impact of COVID-19 on law enforcement investigative operations.
What is the DOJ zero tolerance policy?
Read the DOJ OIG's report on the DOJ's planning and implementation of its zero tolerance policy for immigration offenses involving illegal entry and attempted illegal entry into the United States.