OIG Releases Advisory Opinion
The Department of Health and Human Services Office of Inspector General (“OIG”) released Advisory Opinion 21-12, which reviews a critical access hospital’s (“CAH”) proposal to not bill patients or their insurers for certain items and services provided as treatment for complications occurring within 90 days of a joint replacement procedure performed by its employed orthopedic surgeons. After considering various elements of the proposed arrangement, the OIG concluded that while the proposed arrangement would generate prohibited remuneration under both the federal anti-kickback and the prohibition on beneficiary inducements statutes, the OIG would not impose administrative sanctions.
OIG Conducts 2021 Nationwide Fraud Enforcement Action
The OIG, in partnership with the Department of Justice (“DOJ”) and other federal and state law enforcement agencies, announced the results of their joint 2021 National Health Care Fraud Enforcement Action. This year’s joint action resulted in 138 individuals (including over 42 licensed health care providers) in 31 federal districts being charged with participating in various health care fraud schemes involving more than $1.4 billion in alleged losses to federal health care programs and private insurance companies. Approximately $1.1 billion of these alleged losses were connected to telemedicine fraud, $29 million to COVID-19 fraud, $133 million to fraud involving substance abuse treatment facilities, and $160 million to other health care fraud and illegal opioid prescription/distribution schemes. More information can be found here.