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>>
OIG has been busy cracking down on providers who employ or contract with excluded persons or contractors. In fact, by the end of July OIG settled 27 exclusion violation cases through investigations or self-disclosures. By way of reminder, there were 60 enforcement actions related to OIG exclusion violations in 2014. Following is our 2015 mid-year… more>>
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>>
I. OIG Report In the Office of the Inspector General's (OIG) semiannual report to Congress, it claimed credit for excluding 2,297 individuals and entities from Medicare, Medicaid, and other Federal health care programs. The OIG also claimed credit for initiating 506 criminal and 267 civil actions. According to the OIG report, most of the exclusions resulted from convictions for crimes… more>>
Providers are often surprised to learn that a person can be excluded from participation in federal health care programs because of student loan default. In fact, the failure to repay student loans is one of the most common reasons people find themselves on an exclusion list.1 I. Federal Regulations Surrounding Student Loan Default & Exclusions The… more>>
I. Civil Monetary Penalties Twenty-five out of the fifty-five exclusion enforcement actions reported in 2014 have occurred in home health, hospice, or nursing and rehabilitation facilities. The Civil Monetary Penalties (CMPs) imposed in these cases range from $10,000 to $428,935 for employing just one individual that the employer knew or should have known was excluded… more>>
I. Mandatory OIG Exclusions When the Office of Inspector General (OIG) considers imposing a mandatory exclusion, it sends the individual or entity a Notice of Intent to Exclude.[1] The Notice includes the reason for the proposed exclusion and the possible effect of an exclusion. It also gives the individual or entity 30 days to respond in… more>>
HHS/OIG Deputy Inspector General Gary Cantrell testified earlier this year that States are failing to report all of the adverse actions taken by their Licensing Boards. He suggested that the “manner and time of the [reported] notices” are unreliable. Cantrell attributed these concerns to the “voluntary” nature of State reporting obligations.[1] I. The Impact on Exclusion… more>>