OIG Enforcement Actions

Pharmacies Targeted for Exclusion Violations by OIG and States

By Catalina Jandorf In what appears to be a growing enforcement trend, the Department of Health and Human Services, Office of Inspector General (HHS/OIG) and State Medicaid Fraud Units are aggressively pursuing pharmacy retailers for exclusion violations.  In recent investigations, pharmacies are being targeted for failing to screen prescribers as well as employing pharmacists who have been… more>>

Excluded Dentist Pays Record $1.1 Million and Agrees to 50 Year Exclusion

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>>

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>>

Excluded Employees Cost Hospitals Over $1.5 Million in Civil Penalties

I. Excluded Employees cost Hospitals $1.64 Million in Penalties In the past two months, the Health and Human Services, Office of Inspector General (HHS/OIG) has announced the imposition of over $2 million in penalties in cases involving excluded employees.  The total amounted to more than $2 million in Civil Money Penalty (CMP) settlements. Out of these settlements, three hospitals… more>>

Medicare Fraud Act of 2016 Expands OIG Exclusion Authority

  I. Closure of OIG Exclusion Loophole The U.S. Department of Health and Human Services, Office of Inspector General's  (HHS/OIG)  exclusion authority may be expanded to exclude certain individuals with a prior interest in sanctioned entities. U.S. House of Representative Lois Frankel introduced a bill called "The Fighting Medicare Fraud Act of 2016" on May 17, 2016. This bill will close… more>>

OIG Issues Updated Criteria for Implementing Its Permissive Exclusion Authority

On April 18, 2016, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) issued updated criteria for assessing and evaluating the imposition of permissive exclusions under Section 1128(b)(7) of the Social Security Act. The update replaces the 1997 Federal Register notice and demonstrates the OIG’s ongoing interest in the implementation and enforcement… more>>

Medicare Exclusion Checks Will be Audited by OIG

By Paul Weidenfeld In October of 2015, the Department of Health and Human Services, Office of Inspector General (HHS/OIG) issued its “Work Plan: Fiscal Year 2016.” The purpose of the Work Plan is to summarize new and ongoing OIG reviews with respect to HHS-programs and operations. Notably, both Medicare Exclusion and Medicaid Exclusion issues will be covered… more>>

Pennsylvania Judge Holds that CIA violations May Result in FCA Liability

  In late July, a federal district court in Pennsylvania joined in the flurry of False Claims Act (FCA) decisions. These decisions further interpreted the ACA’s amendments to the law. The court in United States ex rel. Boise v. Cephalon, Inc. considered two important issues. The issues regarded when a party has an obligation to pay… more>>

Review of February, 2014 Exclusion Cases: Focus on Nursing Homes Remains High and the Cost of Violations Rise

I. OIG Targets Nursing Homes Last year almost half of the exclusion violation matters reported by the Office of the Inspector General (OIG) involved nursing homes and rehabilitation facilities. This trend is continuing. Last month, the OIG reported five new cases on its website. Three of the five involved nursing homes. A fourth involved a non-profit school… more>>

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