State Enforcement Actions

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>>

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>>

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>>

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>>