Exclusion News

Pennsylvania Judge Holds that CIA violations May Result in FCA Liability

  In late July, a federal district court in Pennsylvania joined in the flurry of False Claims Act (FCA) decisions. These decisions further interpreted the ACA’s amendments to the law. The court in United States ex rel. Boise v. Cephalon, Inc. considered two important issues. The issues regarded when a party has an obligation to pay… more>>

Exclusion Screening Required in United States Territories

Our experts at Exclusion Screening, LLC maintain fact sheets that contain the screening requirements for providers in every state, including those states that do not currently maintain a separate excluded or terminated provider list. However, Medicaid participation and adherence to exclusion screening requirements does not stop with the fifty states. United States territories like Puerto… more>>

Medicaid Providers That Are Excluded or Terminated for Cause Often Continue to Participate in Other States According to a New OIG Audit

  OIG Audit Findings In a recently released audit, the OIG found that despite the ACA requirement that states terminate Medicaid providers already terminated in another state, 12% of providers already terminated for cause in 2011 in one state (295 out of a sample of 2,539) were still participating in other state Medicaid programs as… more>>

Exclusion Alert: Assistant Inspector General Tells Congress That Exclusion Violations Plague Part D

Assistant Inspector General Testifies before Congress Ann Maxwell, the Assistant Inspector General for Evaluation and Inspections, recently testified before Congress. She argued that the Centers for Medicare and Medicaid Services (CMS) had not exercised “sufficient oversight of plan sponsors,” and “needed to strengthen its controls” in order to prevent payments for drugs “to providers excluded… more>>

OIG Announces Creation of Special Unit for CMP and Exclusion Litigation

  Exclusion Screening, LLC has been chronicling the Office of Inspector General’s (OIG) interest in exclusion enforcement for quite some time. Hence, yesterday’s announcement that the OIG created a special litigation unit focusing on Civil Money Penalties (CMP) and Exclusions comes as no surprise to us. Only two weeks ago we published an article on the OIG’s increasing… more>>

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