The following is a summary of the federal Department of Health and Human Services' Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported are based upon federal and individual states' activity.

The summaries reflect areas of OIG's and individual states' current and recent enforcement activity. Knowing where regulators' attention is focused can help healthcare providers identify areas of focus for compliance and risk assessment activities. Although not all the enforcement actions may be relevant to any one provider's healthcare business, there may be some summaries that could be used as examples in compliance program education ("What to avoid"), or used in developing a risk management plan. (Note: An Acronym Key appears at the end of the Report.)

Of Note in this Issue:

1. SNF settled FCA billing allegations for services provided by a hospice, while patients were admitted to hospice care and services were covered by hospice benefits under Medicare.
2. A New York physician-owned medical practice, allegedly submitted claims for services by physicians when a physician assistant actually provided the service without meeting Medicare's incident-to billing requirements (i.e., physician being physically present in the office and immediately available to furnish assistance and direction throughout the procedure when services are provided by a non-physician practitioner.)
3. Two for-profit SNFs and five employees...

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