Exclusion News

OIG Issues Advisory Opinion on Exclusions

I.  Advisory Opinion on Payments for Services Provided Prior to Exclusion The Department of Health and Human Services Office of the Inspector General (OIG) issued an advisory opinion in response to payments received by an excluded provider for services performed prior to the effective date of his or her exclusion.[1] The individual entered a criminal plea and a civil settlement to… more>>

2014 In Review – OIG Crack Down on Exclusion Violations

I.  CMPs doubled in OIG Exclusion Violations 2014 Exclusion Screening, LLCSM dedicates a significant amount of time to examining the Office of the Inspector General’s (OIG) enforcement actions as they relate to exclusion violations. As a broad overview, in 2014 HHS-OIG imposed $10.54 million in Civil Monetary Penalties (CMPs) on providers that “knew or should have known” one… more>>

OIG Trumpets Exclusions, New Actions and Recoveries in its Semi-Annual Report to Congress

I.  OIG Report In the Office of the Inspector General's (OIG) semiannual report to Congress, it claimed credit for excluding 2,297 individuals and entities from Medicare, Medicaid, and other Federal health care programs. The OIG also claimed credit for initiating 506 criminal and 267 civil actions. According to the OIG report, most of the exclusions resulted from convictions for crimes… more>>

Home Health and Nursing Home Facilities a Major Target for OIG Enforcement

I.  Civil Monetary Penalties Twenty-five out of the fifty-five exclusion enforcement actions reported in 2014 have occurred in home health, hospice, or nursing and rehabilitation facilities. The Civil Monetary Penalties (CMPs) imposed in these cases range from $10,000 to $428,935 for employing just one individual that the employer knew or should have known was excluded… more>>

OIG Proposes Amending Rules to Increase its Civil Monetary Penalty and Exclusion Authority

In May 2014, the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services published two proposed rules to implement provisions of the Affordable Care Act (ACA). The new rules add and expand upon OIG’s current exclusion and Civil Monetary Penalty (CMP) authority. I.  Revisions to OIG's Exclusion Authority  The new… more>>

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