In 2024, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) provided useful insights to the healthcare industry regarding how it approaches various fraud and abuse issues in an increasingly complex healthcare environment. OIG identified several critical risk areas facing federal healthcare programs, issuing a Special Fraud Alert on Medicare Advantage Marketing and reports on using health risk assessments in Medicare Advantage (MA) and billing for Remote Patient Monitoring (RPM). OIG also settled with stakeholders who self-disclosed conduct for tens of millions of dollars, issued important advisory opinions and FAQs, published new compliance program guidance, all while continuing to defend the agency’s interpretation of the anti-kickback statute in defensive litigation related to advisory opinions.
Bass, Berry & Sims is pleased to share this third annual HHS-OIG Year In Review (HHS-OIG YIR). It provides the healthcare industry with a novel resource that highlights key guidance, significant self-disclosure settlements, new compliance guidance, and other significant OIG issuances. In this year’s HHS-OIG YIR, we discuss the following topics:
- Nursing Facility Industry Segment-Specific Compliance Program Guidance
- Special Fraud Alert on MA Marketing Arrangements
- New Frequently Asked Questions (FAQs)
- Various Office of Evaluation and Inspections (OEI) Reports
- Growing Focus on Public Health Grants and Contracts
- Additional Oversight of RPM in Medicare
- Key Advisory Opinions
- Significant Self-Disclosure Protocol (SDP) Settlements
- Litigation Against HHS and OIG
- Potential Impact of Loper Bright and Other Recent Supreme Court Decisions on AKS and Civil Monetary Penalties (CMPs)
- January 24, 2025 Firings of Inspectors General
We hope this year’s HHS-OIG YIR helps you better understand OIG’s priorities and how OIG frames and analyzes fraud and abuse issues so that you can identify and manage your organization’s risks in the complex and ever-changing healthcare regulatory environment.