(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>>
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(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>>
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>>
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>>
(August 23, 2018): In 2008, after learning that a Texas-based laboratory services company was submitting false claims to the Medicare program, a private citizen filed suit, on behalf of the United States, against the laboratory services company under the qui tam provisions of the civil False Claims Act. The qui tam provisions of the False… more>>
Health Care Providers Should Consider the Ramifications of “Taking a Plea” in a Criminal Case or Agreeing to a Licensure Action. It May Trigger a Mandatory or Permissive OIG Exclusion Action.
(July 16, 2018): Perhaps the most severe administrative sanction available under the Social Security Act stems from the authority of the Secretary for the Department of Health and Human Services (HHS) to exclude individuals and entities from participating in Federal and State health benefits programs. The Secretary has delegated this authority to the HHS, Office… more>>
(January 22, 2018): With 2017 behind us, it can be quite helpful to review the Medicare “exclusion” actions taken by the Department of Health and Human Services, Office of Inspector General (HHS-OIG) to gauge the level of regulatory exclusion risk presented by aides and attendants working for personal care agencies around the country. As a review… more>>
(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>>