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What Medicare Advantage Organizations Need to Know About OIG’s 2026 Compliance Guidance

By Julie Mardini on Posted in Compliance, Medicare Advantage, OIG
In February 2026, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released new Industry Segment-Specific Compliance Program Guidance (Guidance) for Medicare Advantage Organizations (MAOs). While the guidance is not legally binding, it provides a detailed roadmap for managing compliance risks and strengthening oversight across Medicare Advantage operations. The guidance is … Continue Reading

HHS OIG Introduces Managed Care Strategic Plan

By Squire Patton Boggs on Posted in Compliance, Fraud and Abuse, HHS, Insurance, Managed Care, Medicare Advantage, OIG
In August, the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services (“HHS”) introduced a new “Strategic Plan for Oversight of Managed Care for Medicare and Medicaid” (the “Strategic Plan”).  The introduction of the Strategic Plan is in response to the continued growth of managed care in government sponsored health … Continue Reading

CMS Blanket Stark Waivers will Terminate Upon End of COVID-19 Emergency

By Robert Nauman and John Wyand on Posted in Anti-kickback Statute, CMS, COVID-19, OIG, Section 1135 Waivers, Stark Law
Earlier this year, the U.S. Department of Health and Human Services (“HHS”) announced the expiration of the COVID-19 public health emergency declarations effective May 11, 2023.  As a result, many of the regulatory waivers and flexibilities available to health care providers, including the blanket waivers applicable to many Stark Law requirements (the “Stark Waivers”), will … Continue Reading

CMS Delays Publication of Final Rule Implementing Stark Law Changes to 2021.

By Robert Nauman on Posted in Anti-kickback Statute, Civil Monetary Penalties Law, CMS, OIG, Stark Law
As we reported last October, CMS and the OIG issued proposed rules aimed at updating the Stark Law, Anti-Kickback Statute, and Civil Monetary Penalties Law as part of HHS’ Regulatory Sprint to Coordinated Care. In part, the proposed rules seek to address the current value-based and coordinated healthcare environment. While publication of final rules concerning … Continue Reading

HHS OIG says “Ditto” to HHS Blanket Stark Waivers for Purposes of the Anti-Kickback Statute

By Robert Nauman on Posted in Anti-kickback Statute, COVID-19, OIG
On April 3, the Department of Health and Human Services Office of the Inspector General (HHS OIG) released a policy statement to align its enforcement of the federal Anti-Kickback Statute (AKS) with HHS’s recent Blanket Waivers of Stark (Blanket Waivers) during the COVID-19 pandemic. As previously reported, HHS issued the Blanket Waivers to allow for … Continue Reading

HHS OIG Flags $2.2 Billion in Potential Medicare Advantage Overpayments for CMS Audits

By Colin Jennings on Posted in CMS, Medicare Advantage, OIG, Reimbursement
CMS said it plans to audit risk-adjustment payments that Medicare Advantage (MA) plans received based on having identified additional diagnoses in beneficiary medical chart reviews. CMS’s action was spurred by a recent report from the HHS Office of Inspector General (OIG) entitled, “Billions in Estimated Medicare Advantage Payments From Chart Reviews Raise Concerns.” (Click here … Continue Reading

Proposed Changes to the Anti-Kickback Statute, Stark Law and Civil Monetary Penalties Law Address Value-Based Healthcare Environment

By Robert Nauman on Posted in Anti-kickback Statute, Civil Monetary Penalties Law, CMS, Department of Health and Human Services, Fraud and Abuse, OIG, Proposed Rule, Regulations, Stark Law, Uncategorized
On October 9, the Department of Health and Human Services (HHS) released proposed rules (the Proposed Rules) aiming to update the Anti-Kickback Statute (the AKS), Stark Law and Civil Monetary Penalties Law (CMPL) to address today’s value-based and coordinated healthcare environment. The proposals reflect a recognition on HHS’s part that the healthcare landscape of today … Continue Reading

OIG Expands Anti-Kickback Statute and Civil Monetary Penalties Protections (Part 2)

By Robert Nauman on Posted in Anti-kickback Statute, Civil Monetary Penalties Law, Fraud and Abuse, OIG
As we discussed in a previous post, the Department of Health and Human Services Office of Inspector General (OIG) published a final rule (Final Rule) amending the safe harbors to the Anti-Kickback Statue (AKS) and also amending exceptions to the Civil Monetary Penalties rule (CMP), providing greater protection for certain arrangements with beneficiaries. In this second … Continue Reading

OIG Expands Anti-Kickback Statute and Civil Monetary Penalties Protections

By Robert Nauman on Posted in Anti-kickback Statute, Civil Monetary Penalties Law, Department of Health and Human Services, Fraud and Abuse, OIG
Late last year, the Department of Health and Human Services Office of the Inspector General (OIG) published a final rule (Final Rule) that amends the safe harbors to the federal Anti-Kickback Statute (AKS) by modifying an existing safe harbor, adding new safe harbors and codifying existing statutory provisions that provide further protections from sanctions under the … Continue Reading

AHA Renews Objections to OIG Hospital Compliance Reviews

By James Hafner on Posted in Compliance, Department of Health and Human Services, Hospitals, OIG, Reimbursement
In a move that could affect all hospitals reimbursed by Medicare, the American Hospital Association (AHA) this week renewed strenuous objections to various aspects of ongoing hospital compliance reviews conducted by the Department of Health and Human Services (HHS) Office of Inspector General (OIG). AHA’s most recent correspondence references the “numerous legal defects” it had … Continue Reading

Task Forces in 10 States Target Providers of Services to Elderly

By Robert Nauman and James Hafner on Posted in CMS, Compliance, Department of Health and Human Services, False Claims Act, Fraud and Abuse, HIPAA, Hospitals, Ohio, OIG, Reimbursement
On March 30, 2016, the US Department of Justice (DOJ) announced that healthcare providers who serve the elderly in the following 10 states will have task forces looking over their shoulders: California, Georgia, Kansas, Kentucky, Iowa, Maryland, Ohio, Pennsylvania, Tennessee and Washington. Known as the Elder Justice Task Forces (Task Forces), these partnerships combine the … Continue Reading

OIG Puts Muscle Behind Its Alert

By Squire Patton Boggs on Posted in Anti-kickback Statute, Compliance, Department of Health and Human Services, False Claims Act, Fraud and Abuse, Hospitals, OIG, Physician Practice, Regulatory Compliance, Uncategorized
Only two days after releasing its latest fraud alert, a deputy director from HHS’s Office of Inspector General announced that the OIG will be hiring additional attorneys to look into taking more administrative actions against physicians in their individual capacity. This announcement emphasizes that the OIG means serious business – not only is the OIG … Continue Reading

OIG Warns Physicians Regarding Noncompliant Agreements

By Robert Nauman on Posted in Fraud and Abuse, OIG, Physician Practice
Tuesday, the OIG released a fraud alert advising physicians to ensure their compensation arrangements, such as medical director agreements, reflect fair market value for bona fide services the physicians actually provide, or they could potentially face liability under the Anti-Kickback Statute.  As part of the fraud alert, the OIG encouraged physicians “to carefully consider the … Continue Reading
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