The Proposed Expansion of CMS’ Revocation Authority Makes Monthly Exclusion Screening of ALL Employees More Important than Ever!

(November 2, 2021):  The Centers for Medicare and Medicaid Services (CMS)[1] is the Federal agency tasked with the overall responsibility of managing the Medicare program. Thus, while the Office of Inspector General (OIG) is the primary agency responsible for protecting the integrity of the Medicare program, CMS and its various contractors serve as the program’s… more>>

Alabama Exclusion Screening Requirements

(May 2, 2019) The Alabama Medicaid Program imposes significant exclusion screening requirements on its providers.  Many are unaware of the extent of their exclusion screening obligations or of the severe consequences that can result from a failure to properly screen.  This short summary has been prepared to help further provider awareness of the exclusion screening rules… more>>

California Exclusion List Screening Requirements

What are the California Exclusion List Screening requirements?  The Medi-Cal Program will not pay for any item or service furnished directly or indirectly by individuals or entities that have been excluded or suspended from the Medi-Cal Program or that have been placed on the Office of Inspector General’s Exclusion List.  This results in a broad… more>>

Dental OIG Exclusions – A Review of 2017 Actions.

(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>>

Reciprocal Licensure Actions Can Lead to Medicare Revocation and Exclusion

(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.[1]  A recent case aptly illustrates how a… more>>

The New “Seventh Element” of Compliance: Screening and Evaluating Employee Suitability!

The recently issued Resource Guide for Measuring Compliance Program Effectiveness, reconfigures the traditional formulation of the “Seven Elements of an Effective Compliance Program by making the “Screening and Evaluation of Employees, Physicians, Vendors and other Agents” an element unto itself – or the new “Seventh Element of Compliance!” The Resource Guide, a product of roundtable discussions… more>>

DOJ Announces $4.7B in FCA Recoveries: What Does It Mean?

DOJ Announces $4.7 billion in FCA Recoveries By Paul Weidenfeld December 16, 2016 The "Third Best Year" in False Claims Act History? The Department of Justice announced earlier this week that FY 2016 was its third best year in “False Claims Act History” with recoveries of more than $4.7 billion in settlements and judgments. Though it… more>>

OIG Imposes Record Penalties for Exclusion Violations

OIG Imposes Record $21.5 Million in Penalties for Exclusion Violations! The OIG imposed a record $21.5 million civil money penalties and restitution against an Ohio corporation that operates pharmacies and supermarkets in 34 states for exclusion violations involving the employment of excluded individuals and fulfilling prescriptions by excluded prescribers! The settlement alleged that the company filled… more>>

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