New York Office of the Medicaid Inspector General’s (OMIG) 2013 annual report provides an important insight into the agency’s activities, recoveries and where it plans to focus its resources in the upcoming year.
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Stress, financial difficulties, effects of aging, declining health and a myriad of other pressures could lead to poor work performance and imperil the license of healthcare professionals. A program designed to assist healthcare professionals in recovery may help. The New Jersey Professional Assistance Program (NJPAP or the Program) monitors and provides support in the recovery of physicians, pharmacists, dentists, nurses and other health care professionals. The Program not only assists in the recovery from drug or alcohol use or dependence but also from other health impairments, such as cognitive impairments, hypertension, diabetes, physical disabilities or depression. NJPAP can also play an important part in protecting a professional’s license. On October 16, 2014, the New Jersey Department of Health (DOH) received a petition from the Executive Director of the Coalition for Medical Marijuana of New Jersey to amend certain New Jersey Medical Marijuana Program Rules. The Office of Inspector General (OIG) within the U.S. Department of Health and Human Services recently issued two reports reminding providers and suppliers of the importance of carefully vetting their business arrangements before signing on the dotted lines. A July Government Accountability Office (GAO) report identified deficiencies in the Centers for Medicare & Medicaid’s Services (CMS) oversight of Medicare audit contractors. The GAO Report further bolstered the long standing provider concerns about the auditing process. New York State Department of Health (DOH) recently issued a clarification concerning certain pharmacy claims that were rejected because the ordering/prescribing/referring/attending (OPRA) provider was an unlicensed resident, intern or a foreign physicians in training programs. Earlier this year, the New Jersey Board of Medical Examiners (BME) issued a Certificate of Waiver to all New Jersey licensed physicians waiving enforcement of rules requiring a prescription to be written in the name of a person to whom a drug is administered (allowing prescription to be written to friends, family or first responders), examination before and follow-up after the issuance of a script. The Waiver is in effect for a year or until the BME adopts revised regulations. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released a special fraud alert (Alert) in June concerning suspect arrangements between laboratories and physicians that raise Anti-Kickback statute (AKS) concerns. The U.S. Health and Human Services (HHS) issued a final rule on July 31, which extended the deadline for the implementation of the tenth revision of the International Classification of Diseases (ICD-10), from October 1, 2014 to October 1, 2015. The final rule requires the continued use of ICD-9 through September 30, 2015. On August 6, 2014, the Centers for Medicare and Medicaid Services (CMS) began implementing a new fingerprint-based background check requirement for individuals with 5% or greater ownership interest in providers and suppliers that fall into a high-risk category and are either currently enrolled or have pending enrollment in Medicare. This screening process will be conducted in phases and not all entities in the high-risk screening category will be subject to the first phase. On July 29, 2014, the Centers for Medicare and Medicaid Services (CMS) announced an extension on the temporary moratoria on new provider enrollment applications as well as on applications adding additional practice locations for Home Health Agencies (and related sub-units) and Part B ambulance suppliers. The temporary moratoria is for an additional six months. The U.S. Food and Drug Administration (FDA) has recently changed its guidelines for products containing acetaminophen to protect the public against the risk of acetaminophen-induced liver injury. On July 30, 2011, the Centers for Medicare & Medicaid (CMS) implemented its new Fraud Prevention System (FPS), which uses predictive analytics technology, similar to that utilized by credit card companies, to move away from the “pay and chase” model to instead detect aberrant or fraudulent billing patterns prior to payment of claims. According to CMS, by fiscal year 2013, CMS was able to take administrative action against 938 providers and suppliers using FPS, saving or preventing $210.7 million in payments. The Centers for Medicare & Medicaid (CMS) is proposing rule changes to streamline the implementation of the Sunshine Act. The U.S. Department of Health and Human Services Office for Civil Rights (OCR) reached a major settlement with a non-profit covered entity (CE) resolving allegations of violation of the HIPAA Privacy Rule for allegedly failing to appropriately and reasonably safeguard protected health information. Pursuant to the requirements imposed by the Affordable Care Act (ACA), New Jersey Division of Medical Assistance and Health Services is beginning a revalidation process of all NJ FamilyCare (NJFM) fee-for-service (FFS) providers. 
We are pleased to announce that we have moved to a new office location. Our new headquarters is located at: 5 Auer Court, Suite H, East Brunswick, NJ 08816. In an effort to curb black market sale of prescription painkillers New Jersey is implementing changes to its paper prescription blanks. These changes represent the first change to the State’s prescription blanks since 2004. The Centers for Medicare & Medicaid Services (CMS) announced that it will begin implementing the fingerprint-based background checks for providers and suppliers in certain risk categories. The New York State’s Office of the Medicaid Inspector General (OMIG) has released its program of activities for the current fiscal year. As in previous years, the agency’s audit and investigation function remain strong. |
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