Why is the OIG investigating Medicare telehealth services?
With this in mind, the OIG’s overarching goal is to detect possible weaknesses in the Medicare telehealth services being offered, said Donald White, a spokesperson for OIG, in a phone interview.
Does my submission of a question obligate OIG to take action?
Your submission of a question does not obligate OIG to take action, including responding to the question, making the question public, or issuing public feedback. 4 42 U.S.C. § 1395nn; 42 U.S.C. § 1396b (s).
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 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 is the role of the OIG in the healthcare industry?
Since its 1976 establishment, the Office of Inspector General (OIG) has been at the forefront of the Nation's efforts to fight waste, fraud and abuse and to improving the efficiency of Medicare, Medicaid and more than 100 other Department of Health & Human Services (HHS) programs.
Why does the OIG exclude individuals from health care?
Permissive exclusions: OIG has discretion to exclude individuals and entities on a number of grounds, including (but not limited to) misdemeanor convictions related to health care fraud other than Medicare or a State health program, fraud in a program (other than a health care program) funded by any Federal, State or ...
What are OIG guidelines?
OIG has developed a series of voluntary compliance program guidance documents directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers, to encourage the development and use of internal controls to monitor adherence to ...
What is the OIG model compliance plan?
Compliance plans offer the health care provider an opportunity to participate in a nationwide effort to reduce fraud and abuse in our national health care programs. The OIG believes that through a partnership with the private sector, significant reductions in fraud and abuse can be accomplished.
What is an OIG sanction?
An OIG Exclusion is a final administrative action by the Office of the Inspector General (OIG) that prohibits participation in any Federal Health Care Program. Exclusions are imposed because the individual or entity is found to pose unacceptable risks to patient safety and/or program fraud.
What are the 3 statutory goals of an OIG?
OIG provides independent and objective oversight that promotes economy, efficiency, and effectiveness in the programs and operations of HHS.
What are the seven OIG elements of an effective compliance plan?
They are as follows:Designation of a compliance officer and compliance committee. ... 2. Development of compliance policies and procedures, including standards of conduct. ... Developing open lines of communication. ... Appropriate training and education. ... Internal monitoring and auditing. ... Response to detected deficiencies.More items...•
What is the OIG exclusion list?
Exclusions. The Office of Inspector General's List of Excluded Individuals/Entities (LEIE) provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid, and all other Federal health care programs.
What happens during an OIG investigation?
The OIG reviews the information and makes an initial determination of what action is required. If an allegation appears to be credible, the OIG will generally take one of three actions: (1) initiate an investigation; (2) initiate an audit or inspection; or (3) refer the allegation to management or another agency.
What are the 7 elements of compliance?
Seven Elements of an Effective Compliance ProgramImplementing Policies, Procedures, and Standards of Conduct. ... Designating a Compliance Officer and Compliance Committee. ... Training and Education. ... Effective Communication. ... Monitoring and Auditing. ... Disciplinary Guidelines. ... Detecting Offenses and Corrective Action.
How do I ensure Medicare compliance?
Seven steps to complianceDevelop standards of conduct. ... Establish a method of oversight. ... Conduct staff training. ... Create lines of communication. ... Perform auditing and monitoring functions. ... Enforce standards and apply discipline. ... Respond appropriately to detected offenses.
How many elements are included in the OIG model compliance guidance?
In developing an effective compliance program, the OIG has identified 7 fundamental elements.
What is OIG in healthcare?
The Office of Inspector General (OIG) recognizes that, in the current public health emergency resulting from the outbreak of the COVID-19, the health care industry must focus on delivering needed patient care. 1 As part of OIG's mission to promote economy, efficiency, and effectiveness in HHS programs, we are committed to protecting patients by ensuring that health care providers have the regulatory flexibility necessary to adequately respond to COVID-19 concerns. Therefore, OIG is accepting inquiries from the health care community regarding the application of OIG's administrative enforcement authorities, including the Federal anti-kickback statute and civil monetary penalty (CMP) provision prohibiting inducements to beneficiaries (Beneficiary Inducements CMP). 2 If you have a question regarding how OIG would view an arrangement that is directly connected to the public health emergency and implicates these authorities, please submit your question to OIGComplianceSuggestions@oig.hhs.gov. In your submission, please provide sufficient facts to allow for an understanding of the key parties and terms of the arrangement at issue. 3 OIG will update the FAQ site as we respond to additional frequently asked questions.
What is an OIG advisory opinion?
An OIG advisory opinion is a legal opinion issued by OIG to one or more requesting parties about the application of the OIG's fraud and abuse authorities to the party's existing or proposed business arrangement.
What is OIG policy statement?
The " OIG Policy Statement Regarding Application of Certain Administrative Enforcement Authorities Due to Declaration of Coronavirus Disease 2019 (COVID-19) Outbreak in the United States as a National Emergency " does not incorporate sections II (B) (12)- (18) of the blanket waivers of the physician self-referral law as issued by the Secretary.
What are the incentives offered by OIG?
OIG is aware that a broad range of entities are offering a wide variety of incentives and rewards (e.g., food and beverages, tickets to concerts and baseball games, cash) to individuals who receive the COVID-19 vaccine.
What is a public health emergency?
1 The Secretary of the Department of Health and Human Services (HHS) determined, through a January 31, 2020, determination, pursuant to section 319 of the Public Health Service Act, that a public health emergency exists and has existed since January 27, 2020. See U.S. Department of Health and Human Services, Determination that a Public Health Emergency Exists (Jan. 31, 2020), available at https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx (COVID-19 Declaration). The Secretary has issued subsequent 90-day renewals of that original determination. For the purpose of these Frequently Asked Questions (FAQs), the original declaration and any renewals are collectively referred to as the "COVID-19 Declaration."
What section of the self referral law protects referrals?
Sections II (B) (12)- (17) of the blanket waivers of the physician self-referral law protect "referrals," as defined under section 1877 (g) of the Act, rather than "remuneration," and reflect differences in the statutory proscriptions of the physician self-referral law when compared to the Federal anti-kickback statute.
What percentage of Medicare Part B is paid?
Under the Ambulance Fee Schedule, Medicare Part B pays 80 percent of the approved amount, and the beneficiary is responsible for 20 percent of the approved amount as well as the applicable Part B deductible, if it has not yet been met.
When was AO 21-06 posted?
AO 21-06 was posted on June 29, 2021. Regarding a spinal implant manufacturer’s proposal to offer its products to hospitals at a reduced price if the hospitals agree to assume certain duties related to the products. AO 21-05 was posted on May 20, 2021. Regarding the use of a "preferred hospital" network as part of Medicare Supplemental Health ...
What is preferred hospital?
Regarding the use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance ("Medigap") policies, whereby an insurance company would contract with a preferred hospital organization to provide discounts on the otherwise-applicable Medicare inpatient deductibles for its policyholders and, in turn, ...
Value-Based Safe Harbors
In its October 2019 proposed rule, OIG proposed three new safe harbors for remuneration exchanged between or among participants in value-based arrangements and created new terminology to define the universe of value-based arrangements that may qualify for safe harbor protection.
Care Coordination Safe Harbor
The new safe harbor for care coordination arrangements to improve quality, health outcomes, and efficiency, 42 CFR 1001.952 (ee) (the “Care Coordination” safe harbor), protects in-kind remuneration exchanged between a VBE and VBE participant, or between VBE participants, regardless of whether the entities assume any financial risk.
Value-Based Arrangements with Substantial Downside Financial Risk
The second value-based safe harbor is the “value-based arrangements with substantial downside risk” safe harbor, 42 CFR 1001.952 (ff) (the “Substantial Downside Financial Risk” safe harbor).
Value-Based Arrangements with Full Downside Financial Risk
The third value-based safe harbor is the “value-based arrangements with full financial risk” safe harbor, 42 CFR 1001.952 (gg) (the “Full Financial Risk” safe harbor).
Patient Engagement and Support Safe Harbor
OIG finalized a new safe harbor for arrangements for patient engagement and support to improve quality, health outcomes, and efficiency, 42 CFR 1001.952 (hh) (the “Patient Engagement and Support” safe harbor).
CMS-Sponsored Model Arrangements and CMS-Sponsored Model Patient Incentives
Recognizing the need for uniformity and predictability for parties participating in a model or other initiative being tested or expanded by the Center for Medicare and Medicaid Innovation under section 1115A of the Social Security Act (“the Act”) and the Medicare Shared Savings Program under section 1899 of the Act (collectively, “CMS-sponsored models”), OIG finalized a new safe harbor to permit remuneration (i) between and among parties to the arrangements and (ii) in the form of incentives provided by CMS-sponsored model participants and their agents to covered patients..
Cybersecurity Technology and Related Services
OIG finalized a new safe harbor that protects donations of, and discounts for, cybersecurity technologies that prevent, detect, and respond to cyberattacks (the “Cybersecurity” safe harbor) (42 C.F.R. 1001.952 (jj)).
What is the new report from Bright.MD?
A new report from Bright.MD shares insights on how to create a hybrid model of care that raises awareness of those choices and their benefits.
Will Medicare cover telehealth in 2021?
The Centers for Medicare and Medicaid Services is looking to continue telehealth’s expanded role into the future. In its final physician fee schedule for 2021, the agency added more than 60 services to the Medicare telehealth list, which means they will be covered even after the Covid-19 pandemic has ended.