civil monetary penalties and OIG

The Department of Health and Human Services Office of the Inspector General (OIG) has issued an Advisory Opinion (Opinion) in connection with a hospital’s gainsharing arrangement (Arrangement) with a designated group of neurosurgeons who perform spinal fusion surgeries at the hospital. According to the Opinion, the OIG would not impose sanctions because the Arrangement, when viewed in its entirety, is not designed or likely to induce the neurosurgeons to (i) reduce or limit medically necessary services to their Medicare or Medicaid patients, or (ii) increase referrals to the hospital. This Opinion is the latest in a line of earlier advisory opinions to “bless” gainsharing arrangements that meet certain criteria for minimizing the risk of fraud and abuse. Continue Reading OIG Reaffirms Permissibility of Certain Gainsharing Arrangements

On June 30, 2015, the Department of Health and Human Services’ Office of Inspector General (OIG) announced that it would be staffing a new specialty litigation unit whose sole focus will be on levying civil monetary penalties (CMPs) and excluding individuals and entities from participation in Medicare and Medicaid. The litigation unit will be comprised of approximately 10 attorneys when hiring is complete. The announcement came at the annual meeting of the American Health Lawyers Association (AHLA) in Washington, D.C.

The concept of an OIG unit dedicated to CMPs and exclusions is not new, but was apparently delayed due to budgetary constraints. That the OIG’s budgetary constraints have lessened is not surprising: in a 2015 report, the OIG reported an $8 to $1 return on investment for the Health Care Fraud and Abuse Control Program, to which OIG is a key partner.

Robert M. Penezic, an OIG deputy branch chief in charge of the new team, and a presenter at the AHLA conference, predicts that the new unit will lead to an increase in enforcement.

Continue Reading OIG Adds New Litigation Unit Focused on Fines and Exclusions