In-Depth Articles

Pennsylvania Exclusion Screening Requirements

 (May 30, 2019)  In August, 2011, the State Department of Public Welfare issued a bulletin requiring providers to screen employees and contractors upon hire and monthly thereafter by the (Medicheck) Pennsylvania Exclusion List (their corresponding State exclusion/preclusion list), the HHS/OIG List of Excluded Individuals and Entities (LEIE) and the Excluded Party List (EPLS, now the… 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 Screening Requirements

 What are the California Exclusion 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 “suspension”… more>>

New Evidence Shows the Efficiency and Benefits of Using an Internal Compliance Hotline System

New Evidence Shows the Efficiency and Benefits of Using an Internal Compliance Hotline System(April 4, 2019):  In December of 2018 a study was conducted by Kyle Wench (George Washington University) and Stephen Stubben (University of Utah) to examine the use and extent of internal whistleblowing systems within publicly traded organizations. This study was the first… more>>

OIG Exclusion and State Exclusion Lists: Which Exclusion Lists Need to Be Screened? What Is the Difference Between Them?

There are two federal databases that list persons and entities that have been excluded from participating in federal health care programs or receiving federal contracts. Checking and verifying individuals on the OIG Exclusion List of Excluded Individuals and Entities (LEIE) and the GSA System for Award Management (SAM) should be part of any compliance exclusion screening program.… more>>

What to Know About the New CMS Preclusion List

By: Cason Liles(February 12, 2019) Beginning April 1, 2019, CMS’s new Preclusion List will go into effect subsequently barring many healthcare professionals from receiving payment for Medicare Advantage (MA) items and services or Part D drugs furnished or prescribed to Medicare beneficiaries. But what is the Preclusion List? Who is on it? Why was created? Don’t worry,… more>>

A Review of OIG Enforcement Actions in Fiscal Year 2018

By Cason Liles(February 6, 2019): The Department of Health and Human Services (HHS), Office of Inspector General (OIG) is an independent, objective law enforcement and investigative agency that is responsible for protecting the financial integrity of the more than 300 programs that are administered by HHS.  Collectively, these programs represent approximately 24% of the Federal budget. … 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>>

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