(March 1, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG), has continued its goal of enforcing its guidelines and rules upon medical providers participating in their programs. The OIG has kept pursuing its goal of protecting the integrity of its federal health care programs and their respective patients. Several… more>>
(February 6, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG), didn’t skip a beat ringing in the new year. The OIG kept pursuing its goal of protecting the integrity of its federal health care programs and their respective patients. Several notable cases in which the OIG found inaccuracies or… more>>
Concealing Information Regarding an Excluded Party and Lying on a Medicare CMS-855a Enrollment Application Will Swiftly Make a Bad Situation Even Worse!
(January 8, 2019): Since first being enacted in 1965, Congress has enacted a number of measures to safeguard the financial integrity of the Medicare and Medicaid programs. The Medicare-Medicaid Anti-violations Fraud and Abuse Amendments of 1977 (Public Law 95-142) are among the most significant. In addition to making of the Federal Anti-Kickback Statute a felony, the legislation also mandated that… more>>
What Providers Need to Know About Medicaid Exclusions in Texas: Exclusion Screening Requirements and Best Practices for Compliance
(December 17, 2018): The Texas Medicaid Program will not pay for any item or service furnished directly or indirectly by individuals or entities that have been excluded from a State or Federal health care program. This results in a broad “Payment Prohibition” that is enforced by the Texas Health and Human Services Commission, Office of… more>>
Health Care Providers Should Consider the Ramifications of “Taking a Plea” in a Criminal Case or Agreeing to a Licensure Action. It May Trigger a Mandatory or Permissive OIG Exclusion Action.
(July 16, 2018): Perhaps the most severe administrative sanction available under the Social Security Act stems from the authority of the Secretary for the Department of Health and Human Services (HHS) to exclude individuals and entities from participating in Federal and State health benefits programs. The Secretary has delegated this authority to the HHS, Office… more>>
(January 12, 2018): The Medicare and Medicaid programs are both essential, yet costly health benefit programs sponsored in whole or in part by the Federal government. With Medicare and Medicaid costing $686 and $368 billion each year, respectively, the government has dedicated experienced investigators, auditors and prosecutors to ferret out incidents of health care fraud and… more>>
(January 8, 2018): Most physicians will progress through their entire career without ever having to respond to a complaint or investigation by their State Medical Board. Unfortunately, that isn’t always the case. An average of 4,309 physicians are disciplined each year by state licensure boards around the country. A recent case aptly illustrates how a… more>>
OIG Year in Review Podcast Earlier this week, the Office of Inspector General released its “Year in Review” Podcast highlighting the OIG’s major accomplishments for 2017. The podcast reported 881 criminal actions, 826 civil actions and over $4 billion in recoveries. OIG also excluded 3,244 from participating in federal health care programs during the year.Interestingly, the… more>>
Is Your Practice Being Audited by a ZPIC? Did You Know it Can Lead to an OIG Exclusion?Zone Program Integrity Contractors (ZPICs) are among the most aggressive program integrity entities employed by the Centers for Medicare and Medicaid Services (CMS). As most healthcare providers are aware, ZPICs regularly place physician practices on prepayment review and… more>>
By Robert LilesHave you implemented the new “ Advance Beneficiary Notice of Noncoverage ” (ABN), required by the Centers for Medicare and Medicaid Services (CMS)? As CMS has noted, although the latest version of the form (ABN Form CMS-R-131) does not include any substantive changes, in accordance with Section 504 of the Rehabilitation Act of 1973, the… more>>