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OIG issues semiannual report – laundry list of what not to do

December 5, 2006

The OIG’s semiannual report came out today, offering the usual insight in how not to run your business.  The press release offers some highlights, detailing how

OIG’s $38.2 billion in savings and expected recoveries encompasses $35.8 billion in implemented recommendations and other actions to put funds to better use, $789.4 million in audit receivables, and $1.6 billion in investigative receivables.

Interesting items in the report include:

(1) Review of emergency preparedness in Gulf Coast nursing facilities post-hurricanes, yielding the conclusion that the regulations, not the regulated community, need some work; and

(2) Closer to home here in Boston:

OIG identified $87 million in Federal Medicaid overpayments for targeted case management services in Massachusetts. Medicaid pays for targeted case management services to assess Medicaid beneficiaries’ service needs, refer beneficiaries to needed services, and monitor the services. It does not pay for direct social services to which beneficiaries have been referred. However, the State included the costs for direct social services in the rates used to claim reimbursement for targeted case management services. OIG recommended that the State refund the resulting $87 million overpayment.

To quote an old TV cop:  "Be careful out there."

— David Harlow

Filed Under: Anti-Kickback Statute, Fraud and Abuse, Health Law, Hospitals, Medicaid, Medicare, Physicians

you might also like:

  1. OIG issues the Compendium of Unimplemented OIG Recommendations

  2. Swapping arrangements, other issues, addressed in OIG supplemental compliance program guidance for nursing facilities

  3. OIG Issues "Roadmap for New Physicians" – A Guide to Avoiding Fraud and Abuse – and Some Thoughts on its Context

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