(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>>
(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>>
OIG Year in Review Podcast Earlier this week, the Office of Inspector General released its “Year in Review” Podcast highlighting the OIG’s major accomplishments for 2017. The podcast reported 881 criminal actions, 826 civil actions and over $4 billion in recoveries. OIG also excluded 3,244 from participating in federal health care programs during the year.Interestingly, the… more>>
Is Your Practice Being Audited by a ZPIC? Did You Know it Can Lead to an OIG Exclusion?Zone Program Integrity Contractors (ZPICs) are among the most aggressive program integrity entities employed by the Centers for Medicare and Medicaid Services (CMS). As most healthcare providers are aware, ZPICs regularly place physician practices on prepayment review and… more>>
(August 16, 2017): Earlier this summer, the U.S. Department of Justice (DOJ) executed its most extensive “health care fraud takedown” to date, initially arresting 412 licensed healthcare providers, doctors, and nurses alleged to have engaged in fraudulent conduct. As Attorney General Jeff Sessions stated at that time, “We are sending a clear message to criminals… more>>
By Robert LilesHave you implemented the new “ Advance Beneficiary Notice of Noncoverage ” (ABN), required by the Centers for Medicare and Medicaid Services (CMS)? As CMS has noted, although the latest version of the form (ABN Form CMS-R-131) does not include any substantive changes, in accordance with Section 504 of the Rehabilitation Act of 1973, the… more>>
Exclusion News (May 22, 2017): By Paul WeidenfeldHealth Care Fraud will continue to be a high priority of the Department of Justice Kenneth Blanco, the Acting Head of the Criminal Division. Describing health care fraud as “egregious,” “despicable” and driven by “greed” – Mr. Blanco, told the iABA Health Care Fraud Institute last week. went… more>>
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>>
Exclusion Violation by Dentist "Sends a Strong Warning" February 1, 2017 By Paul Weidenfeld The Office of the Inspector General's (OIG) announced last week that it had reached a settlement in excess of a million dollars with an excluded dentist for violations of the provisions of the regulations denying participation in federal health care programs… more>>