How Broad is the Managed Care Safe Harbor?

By Christine Clements on October 26, 2018 Posted in Fraud and Abuse, Medicaid

In Advisory Opinion No. 18-11, the Department of Health and Human Services Office of the Inspector General (the “OIG”) addressed a Medicaid managed care organization’s (“MCO”) proposal to pay its contracted providers and clinics (“Network Providers”) to increase the amount of Early and Periodic Screening, Diagnostic, and Treatment (“EPSDT”) services they provide to the MCO’s … Continue Reading

New DOJ Guidance Policy Limits Use of Guidance Documents in Federal Civil Actions

By Matthew Goldman, Jordan Grushkin and Cody Fierro on February 20, 2018 Posted in Fraud and Abuse

[1] On January 25, 2018, Associate Attorney General Rachel Brand issued a memorandum on behalf of the U.S. Department of Justice (DOJ) (the “Brand Memo”) which effectively limits the use and enforcement power of guidance documents for the purposes of affirmative civil enforcement cases, a development that could have a significant impact on how certain … Continue Reading

New OIG Exclusion Authority Rule Set To Go Into Effect on March 21, 2017

By Kenneth Yood and Jordan Grushkin on March 8, 2017 Posted in Affordable Care Act (ACA), Office of the Inspector General ("OIG")

On January 12, 2017, just a week prior to President Trump’s Inauguration, the Department of Health and Human Service (HHS) Office of Inspector General (OIG) published a final Rule (Rule) regarding one of its most important enforcement mechanisms: its exclusion authority. The Rule, published nearly three years after it was initially proposed by the OIG … Continue Reading