OIG Enforcement Actions: April Exclusions & Notable Decisions

 April ExclusionsOIG Enforcement Actions: Exclusions & Notable Decisions from April 2019

(May 10, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG), has continued its goal of enforcing its guidelines and rules upon medical providers participating in their programs. The OIG has kept pursuing its goal of protecting the integrity of its federal health care programs and their respective patients.  Several notable cases in which the OIG found inaccuracies or fraud are highlighted below:

(April 4, 2019). A Mental Health Service Provider in Maine has Settled a Case Involving Excluded Individual

On April 4, 2019, a mental health service provider located in Maine chose to enter into a $17,750.12 settlement agreement with OIG. The settlement agreement puts to rest claims that the mental health service provider employed an individual who was excluded from participating in MaineCare, Maine’s Medicaid program. By being excluded in Maine, it is safe to say that they also had received an OIG Exclusion. A subsequent OIG investigation revealed that the excluded individual, a counselor, provided items or services to patients that were billed to MaineCare. This is something that the OIG will not stand for and have been cracking down heavily on in the last couple years and should be a reminder to screen your employees!


(April 4, 2019). Three Pharmaceutical Companies Agree to Pay a Total of Over $122 Million to Resolve Allegations That They Paid Kickbacks Through Co-Pay Assistance Foundations

On April 4 , 2019,  three large pharmaceutical companies agreed to pay a whopping amount of $122.6 million to resolve accusations that all three of them had “violated the False Claims Act by illegally paying the Medicare or Civilian Health and Medical Program (ChampVA) copays for their own products, through purportedly independent foundations that the companies used as mere conduits.”[1] This is one of the largest enforcement actions done this past month and should serve as a reminder that healthcare fraud can quickly become costly and bankrupt your organization!

(April 10, 2019).
Social Worker in Connecticut Settles Allegations of  Violating the False Claims Act.

 On April 10, 2019, a Licensed Clinical Social Worker based in Connecticut was forced to enter into a $145,000 settlement agreement with OIG. The settlement agreement resolves allegations that the licensed clinical social worker had  billed Medicaid for  certain psychotherapy services as if they had personally provided those services to patients when actually, she had  unlicensed individuals provided the services. The Licensed Clinical Social Worker is now on a 3 year suspension from the Connecticut Medicaid program. While she is excluded from the Connecticut Medicaid Program, it can take 6-8 months for this to appear on the OIG Exclusion list and website. This should serve as a reminder to screen against all 43 databases and not just the OIG Exclusion List!

(April 24, 2019).  Two Former Medical Executives Agree To Pay $1 Million To Settle Diabetic Testing Supply Fraud Allegations

On April 24, 2019, two former medical executives out of Boca Raton, Florida entered intosettlement agreement with OIG. They were each forced to pay $500,000 to resolve allegations that they had violated the False Claims Act.It was believed that they were submitting false claims into Medicare that “were tainted by kickbacks paid to beneficiaries in the form of free or no cost home blood glucose meters or waived or uncollected copayments.”[2] It was also believed that many of tests that they were administering lacked any evidence of medical necessity.


Concluding Thoughts

During the month of April, the OIG continued to take action against providers that have failed to perform their mandatory exclusion screening obligations as well as added people to their database for other healthcare fraud violations. We here at Exclusion Screening have taken all of the guesswork out of these duties. 

Call us up for a no-obligation quote.  You will be glad you did.  We can be reach at:  info@exclusionscreening.com or by phone, 800-294-0952, or fill out the form below.