News from the Health Law Gurus™: Week of May 11th, 2014

May 16, 2014 | By Lawrence J. Tabas

News from the Health Law Gurus™ is a weekly summary of notable health law news from around the country with helpful links to related content. Check back every Friday for the latest health law news stories.

OIG to Expand Its Exclusion Authority under Proposed Rule—In a proposed rule published in the Federal Register last week, the Office of Inspector General (“OIG”), charged with enforcing fraud and abuse laws protecting federal health care programs, seeks to expand its authority to exclude individuals and entities from programs like Medicare and Medicaid. The proposed rule, based on authority granted by the Affordable Care Act, will allow the OIG to impose an exclusion on an individual or entity based on a conviction for obstructing an audit, for failing to supply payment information, or for making any false statement, omission, or misrepresentation of material facts in applications to participate as a provider or supplier of medical services under a federal health care program. Read the full text of the proposed rule here.

90 Individuals Charged in Seventh National Medicare Fraud Take Down—On Tuesday, Secretary of the Department of Health and Human Services (“HHS”) Kathleen Sebelius and Attorney General Eric Holder announced charges against 90 individuals for approximately $260 million in false Medicare billing. The charges and the subsequent takedown, the seventh such national take down, arise out of investigation by the Medicare Fraud Strike Force, a joint operation between HHS and the Department of Justice comprised of federal, state and local investigators. In announcing the charges, Attorney General Holder stated, “Medicare is a sacred compact with our nation’s seniors, and to protect it, we must remain aggressive in combatting fraud.” Read the full HHS press release here.

Medicaid Enrollment Expands in States that Rejected Medicaid Expansion—According to an Associated Press article, Avalere Health, a market analysis firm, found that Medicaid enrollment has increased in states that have opted not to expand their Medicaid programs under the Obama administration’s health care reforms (states that opted to expand Medicaid eligibility receive additional federal funding for Medicaid programs under the reforms). Georgia, North Carolina, and Montana all saw marked increases in enrollment. These states will need to figure out how pay for these new enrollees without any additional federal funding. Read the full Associated Press article on the Washington Post’s website here.

Second Burwell Confirmation Hearing—Sylvia Mathews Burwell, the Obama administration’s nominee to replace Kathleen Sebelius as Secretary of HHS, appeared before the Senate Finance Committee on Wednesday for her second confirmation hearing. Burwell, currently the Director of the White House Office of Management and Budget, also testified before the Senate Committee on Health, Education, Labor, and Pensions last week. Most commentators are describing the hearings with adjectives like “breezy” and “cordial”, and Burwell is expected to be confirmed without much trouble. Read a New York Times article on the latest confirmation hearing here.

About the Authors

Lawrence J. Tabas


Lawrence is the Chair for Obermayer’s Health Care Law Department and Election Law Practice Group. Lawrence’s Health Care Law legal experience includes the representation of Pennsylvania County governments in Behavioral Health Managed...

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