Exclusion News

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>>

DOJ Announces New FCA Settlements involving Excluded Persons including a $6.5 Million Settlement involving Services Provided by a Private Duty Nurse Investigated by OIG

The Department of Justice (DOJ) recently announced two new False Claims Act (FCA) settlements involving excluded persons. The first was a $6.5 million FCA settlement with a Nashville Home Health Agency. The services of a private duty nurse were identified in both settlement documents and the press release as an important component of the settlement. Although, the exact… more>>

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