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.

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Photo of Richard Arnholt Richard Arnholt

Richard Arnholt advises companies, large and small, on the complex rules and regulations applicable to grants and contracts from federal and state governmental entities. In an era of increased budgetary pressures for contractors, Richard focuses his practice on providing practical business and legal…

Richard Arnholt advises companies, large and small, on the complex rules and regulations applicable to grants and contracts from federal and state governmental entities. In an era of increased budgetary pressures for contractors, Richard focuses his practice on providing practical business and legal guidance to help clients efficiently navigate the minefield of government procurement and grant regulations.

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Kristin Bohl blends her experience as a healthcare attorney in private practice and government service with first-hand knowledge of care delivery as a registered nurse. Kristin advises hospitals, health systems and other provider organizations on compliance and regulatory issues and fraud and abuse…

Kristin Bohl blends her experience as a healthcare attorney in private practice and government service with first-hand knowledge of care delivery as a registered nurse. Kristin advises hospitals, health systems and other provider organizations on compliance and regulatory issues and fraud and abuse matters, with a focus on the wide range of Medicare payment models. Before she entered private practice, Kristin was the Technical Advisor in the Division of Technical Payment Policy at the Centers for Medicare & Medicaid Services (CMS), where she concentrated on Stark Law matters. She was part of a team that developed the CMS Voluntary Self-Referral Disclosure Protocol and provided technical assistance in the creation of Stark Law waivers for Accountable Care Organization (ACO) models and other payment initiatives of the Center for Medicare and Medicaid Innovation within CMS.

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Justin Brown focuses on healthcare fraud and abuse matters, particularly those involving the federal physician self-referral law (Stark Law), the federal Anti-Kickback Statute, and state analogs. He represents hospitals and health systems, ambulatory surgery centers, post-acute care providers, and physician practices, along with…

Justin Brown focuses on healthcare fraud and abuse matters, particularly those involving the federal physician self-referral law (Stark Law), the federal Anti-Kickback Statute, and state analogs. He represents hospitals and health systems, ambulatory surgery centers, post-acute care providers, and physician practices, along with their strategic and financial sponsors, regularly serving as healthcare regulatory counsel for transactions, enforcement actions, and internal investigations, and advising on day-to-day operations. Before entering private practice, Justin was a trial attorney in the Massachusetts public defender’s office.

*Justin Brown is admitted to practice in Alabama and Massachusetts; Tennessee bar application pending

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Stewart Kameen advises healthcare clients on all aspects of federal and state healthcare laws and regulations, with a particular emphasis on fraud and abuse regulatory counseling, corporate compliance, internal investigations and government enforcement actions, qui tam litigation, and transactional matters. Stewart is able…

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Travis Lloyd focuses on complex healthcare regulatory matters. He represents a broad range of healthcare industry clients, including hospitals and health systems, ambulatory surgery centers, post-acute providers, behavioral health providers, and physician practices, as well as their strategic partners. He has significant experience…

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Bill Mathias advises healthcare companies on complex fraud and abuse and Stark Law issues.  He draws on over two decades of experience to address thorny healthcare regulatory questions.  He regularly assists clients with internal and government investigations and corporate compliance matters.

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Photo of Jennifer Michael Jennifer Michael

Jennifer Michael draws on her experience as the former Chief of the Industry Guidance Branch at the U.S. Department of Health and Human Services (HHS), Office of Counsel to the Inspector General (OCIG) to help healthcare providers and life science companies avoid potential…

Jennifer Michael draws on her experience as the former Chief of the Industry Guidance Branch at the U.S. Department of Health and Human Services (HHS), Office of Counsel to the Inspector General (OCIG) to help healthcare providers and life science companies avoid potential fraud and abuse landmines and defend them in fraud and abuse investigations. Jennifer helps her clients structure their arrangements to comply with the federal Anti-Kickback Statute (AKS), the federal Civil Monetary Penalty (CMP) law, and other state and federal fraud and abuse laws and navigate government investigations under the federal False Claims Act (FCA).

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Photo of Christine Morse Christine Morse

Christine Morse advises a wide range of healthcare companies on fraud and abuse claims, reimbursement issues and regulatory compliance. She has extensive experience advising provider organizations on key federal healthcare laws, such as the Stark Law, the Anti-Kickback Statute (AKS) and the False…

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