Organization

Office Of The Inspector General


HHS approves Florida data mining waiver to identify Medicaid fraud

Industry News | Friday, July 16 2010
U.S. Health and Human Services Secretary Kathleen Sebelius has approved the state of Florida’s Medicaid waiver request to help fund a demonstration program that will allow the state’s Medicaid Fraud Control Unit to mine Medicaid Management Information System data to identify cases of potential Medicaid fraud.
 

California rad provider settles whistleblower case for $647K

Top Stories | Tuesday, July 06 2010
Oaks Diagnostics, which owns Advanced Radiology of Beverly Hills, Calif., has paid the federal government $647,000 to settle allegations that it filed false claims with Medicare for unnecessary radiological tests, reported the U.S. Attorney's Office Central District of California.
 

Ohio provider settles kickback scheme with DoJ for $108M

Top Stories | Friday, May 21 2010
The Health Alliance of Greater Cincinnati and one of its former member hospitals, the Christ Hospital, have agreed to pay $108 million to the U.S. government to settle claims that they violated the Anti-Kickback Statute and the False Claims Act by paying unlawful remuneration to doctors in exchange for referring cardiac patients to the Christ Hospital in a pay-to-play scheme, the Department of Justice (DoJ) has reported.
 

OIG: Fraud risks need to be re-examined in face of reform

Industry News | Monday, May 03 2010
New payment and healthcare delivery models require a fresh examination of fraud and abuse risk, according to Daniel R. Levinson, inspector general of the Department of Health and Human Services (HHS), during his keynote address at the Healthcare Compliance Association's Annual Compliance Institute last month.
 

OIG: Adverse event reporting process varies regionally

Industry News | Friday, January 15 2010
It is not appropriate to make a broad recommendation for a public disclosure process for adverse events in hospitals, according to a recent memorandum from the Office of Inspector General (OIG) at the Department of Health and Human Services (HHS).
 

Minnesota Hospital settles whistleblower suit

Top Stories | Thursday, January 07 2010
The Department of Justice has announced that Wheaton Community Hospital, the city of Wheaton, Minn., and Stanley Gallagher, MD, have agreed to pay $846,461 to settle a whistleblower suit charging that they violated the False Claims Act.
 

CMS, ARRA health IT programs slated for OIG audit

Top Stories | Tuesday, November 03 2009
The Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) will audit a number of the Centers for Medicaid & Medicare Services (CMS) programs involving health IT incentives, according to its 2010 work plan. The review also will involve health IT programs funded by the American Recovery and Reinvestment Act of 2009 (ARRA).
 

OIG asserts FDA's CDRH is not efficient

Industry News | Friday, October 30 2009
The FDA's Center for Devices and Radiological Health (CDRH) does not use adverse event reports in a systematic manner to detect and address safety concerns about medical devices, according to an October report from the Office of Inspector General (OIG).
 

Feature: Imaging payments, appropriateness under OIG review

Top Stories | Monday, October 12 2009
Written by Jeff Byers
The Department of Health and Human Services' Office of Inspector General (OIG) will commence new studies regarding Medicare Part B imaging payments and the appropriateness of many emergency department scans, according to the recent OIG Fiscal Year 2010 Work Plan.
 

News & Views

Departments | Tuesday, September 22 2009
Written by Justine Cadet
HIIT070704- CMS supports NCD coverage of FDG-PET for cervical cancer

- OIG cautions CMS about ultrasound overuse
 

OIG: Medicaid isn't properly detecting fraud

Top Stories | Tuesday, September 15 2009
A report from the Office of Inspector General (OIG) for Evaluation and Inspections for the Centers for Medicare & Medicaid Services and State Operations indicates that the Medicaid Statistical Information System was unable to capture many data elements that can assist in fraud, waste and abuse detection between 2004 and 2006.
 

OIG: VA's integration problems reflect system-wide IT issues

Industry News | Wednesday, September 09 2009
The failure of the Department of Veterans Affairs (VA) replacement scheduling application development program is part of a pattern of larger agency system problems related to the implementation and management of IT projects, according to a report by the Office of the Inspector General (OIG).
 

OIG cautions CMS about ultrasound overuse

Top Stories | Sunday, July 26 2009
The Office of the Inspector General (OIG) has released a report expressing concern about the over-utilization of ultrasound devices in specific U.S. counties.

 

Task force uncovers $50M in alleged Medicare fraud; 53 arrested

Top Stories | Wednesday, June 24 2009
Fifty-three people have been indicted for schemes to submit more than $50 million in false Medicare claims in the continuing operation of the Medicare Fraud Strike Force in Detroit, according to an announcement made Wednesday by U.S. Attorney General Eric Holder, Department of Health and Human Services Secretary Kathleen Sebelius and FBI Director Robert Mueller.
 

Report: Hospitals need more accountability, oversight of physician discipline

Top Stories | Monday, June 01 2009
Even though federal law requires it, nearly half of all U.S. hospitals fail to report to the National Practitioner Data Bank when a physician's admitting privileges have been revoked or restricted for more than 30 days, according to a report from consumer watchdog group Public Citizen.
 

Radiologists to pay $2M in Medicare fraud settlement

Top Stories | Monday, March 30 2009
The Office of Inspector General (OIG) for the Department of Health and Human Services has entered into a civil monetary penalty settlement with West Valley Imaging Limited Partnership of Las Vegas, and its principals, William L. Boren, MD, and Luke S. Cesaretti, MD, over claims of Medicare fraud.
 

Three cardiologists settle for $355K over Stark Law violations

Top Stories | Tuesday, March 24 2009
The U.S. government has reached a settlement with cardiologists Richard A. Cohn, MD, Lee Goldberg, MD, and Timothy M. Marshall, MD, of Tucson, Ariz., contending that from January 2007 to October 2007, they submitted payment claims to the Medicare Program in violation of the physician self-referral law, or Stark Law.
 

DoJ joins whistleblower suit against N.M. health system

Top Stories | Monday, March 09 2009
The U.S. Department of Justice (DoJ) has intervened in a whistleblower suit filed in the District of New Mexico against Community Health Systems and three of its hospitals in New Mexico.
 

MedQuist pays $6.6M to DoJ for overbilling

Top Stories | Thursday, December 04 2008
 
The U.S. Department of Justice (DoJ) has reported that medical transcription service provider MedQuist has paid the United States $6.6 million to resolve allegations under the False Claims Act that it overbilled federal government clients.
 

OIG slams CMS for lack of HIPAA compliance enforcement

Top Stories | Monday, November 03 2008
 
The Centers for Medicare & Medicaid Services (CMS) has taken limited actions to ensure that covered entities adequately implement the HIPAA Security Rule of 1996, and has not provided effective oversight or encouraged enforcement of the rule, according to a new report from the Office of the Inspector General (OIG).
 
Web Exclusives

Feature: U.S. needs national strategy to curb imaging overutilization

Medical imaging overutilization--a growing concern in the U.S.--exposes patients to unnecessary radiation, while also adding to rising healthcare costs, according to a study published online Aug. 24 in Radiology. In an interview, William R. Hendee, PhD, lead author, reviewed various methods by which medical imaging could be curtailed.

Radiology: Prelim study shows CE breast CT outperforms CT, mammo

Dedicated contrast-enhanced (CE) breast CT delivered significantly improved conspicuity of malignant breast lesions, including ductal carcinoma in situ (DCIS), compared with unenhanced breast CT and mammography, according to a study published in the September issue of Radiology.

Radiology: Rad role may evolve as image-guided biopsies trend up

CT, ultrasound and MRI have helped shift biopsy techniques away from more invasive approaches toward image-guided percutaneous techniques, according to a study published in the September issue of Radiology. The trend toward less-invasive approaches translates into enhanced safety and efficiency and could lead to more interaction between patients and radiologists.

CMS Webinar: Incentive payments to offset EHR adoption, not reimburse

The Centers for Medicare & Medicaid Services’ (CMS) EHR incentive payments are not considered reimbursement for money expended on EHR technology, but are intended to offset the cost associated with adoption and ongoing meaningful use, according to CMS during an Aug. 12 webinar.

CMS webinar: Eligible professionals can expect EHR incentives in 2011

Funding incentives for EHR use is the main goal of the Centers for Medicare & Medicaid Services' (CMS) meaningful use initiative, and there are incentive programs for both hospitals and eligible professionals, according to Elizabeth Holland, health insurance specialist at the Department of Health and Human Services, who spoke during a CMS-sponsored webinar Aug. 8.

Webinar: Stage 1 of meaningful use is for quality reporting acclimation

Stage 1 requirements for meaningful use incentives aim to strike a balance between the overall goal of EHR use and widespread adoption, while avoiding added work, said Jonathan Teich, MD, PhD, chief medical informatics officer at Elsevier Health Services, during a HIMSS webinar titled “Meaningful Use: Safety and Quality of Care.”

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