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Nursing

Browse through our comprehensive resources designed by exclusion experts to offer you support and guidance.
NYState
A Provider Guide to New York Medicaid Exclusion Screening
This article focuses on helping providers understand New York Medicaid exclusion screening law, and its...
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Alabama Medicaid providers must screen against Alabama’s Exclusion List, the LEIE, and the GSA’s SAM database.
A Provider Guide to Alabama Medicaid Exclusion Screening
Alabama’s Medicaid Program will not pay for any item or service furnished by, or at the medical direction...
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Current States With a Separate Medicaid Exclusion List
Current States With a Separate Medicaid Exclusion List
Map of the States with a Separate Medicaid Exclusion List Click on your state to view their Medicaid...
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Current States With a Separate Medicaid Exclusion List
Comparison between OIG Exclusion List and CMS Preclusion List
OIG Exclusion List vs. CMS Preclusion List Since the CMS Preclusion list was announced in April 2018,...
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Current States With a Separate Medicaid Exclusion List
What is an Exclusion Waiver and Who May Apply for one?
We have previously discussed that once a provider is excluded he may not furnish items or services...
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California Exclusion List Screening Requirements
What are the California Exclusion List Screening requirements?  The Medi-Cal Program will not pay...
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Pennsylvania Medicheck Preclusion List: A Provider’s Guide to Screening
The Pennsylvania Precluded Provider List, commonly referred to as “Pennsylvania Medicheck,” identifies...
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How the LEIE, GSA/SAM, and State Exclusion Lists Differ; And Why They Need to be Screened
Exclusions and debarments are powerful administrative sanctions imposed by Federal and State agencies....
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A Provider’s Guide to the GSA SAM Database.
The importance of screening employees, vendors and contractors against available federal and State exclusion...
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Current States With a Separate Medicaid Exclusion List
Why is it Necessary to Screen Against the NPPES and its NPI Registry Database?
We are sometimes asked, “Why do you screen against the National Plan and Provider Enumeration System...
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California's Medi-Cal Suspended and Ineligible Provider List is Designed to Safeguard Beneficiaries and Protect the Financial Integrity of the Medi-Cal Program.
An Overview of the Medi-Cal Suspended and Ineligible Provider List
Most healthcare providers and suppliers in the State of California are aware that exclusions imposed...
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A Provider's Guide to OIG Exclusions
A Provider’s Guide to OIG Exclusions: Federal Exclusion Regulations and Enforcement Authorities, and...
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What is an OIG Exclusion?
OIG Exclusions are powerful enforcement sanctions that bar an individual or entity from any participation...
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that health care providers review the Social Security Death Master File on at least a monthly basis.
Why Should We Screen Against the Social Security Administration Death Master File?
At Exclusion Screening, we often receive questions about the scope and frequency of an organization’s...
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Resolving Exclusion Violations through the OIG Self-Disclosure Protocol
I. Introduction The Office of Inspector General (OIG) has the authority to exclude providers from participating...
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Medicare / Medicaid Providers Beware: A Nolo Contendere Plea to a Non-Health Care Crime Can Still Result in Exclusion from Medicare
The last two years have been rough for everyone, and it has been particularly difficult for healthcare...
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The Proposed Expansion of CMS’ Revocation Authority Makes Monthly Exclusion Screening of ALL Employees More Important than Ever!
The Centers for Medicare and Medicaid Services (CMS)[1] is the Federal agency tasked with the overall...
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When an Underlying Misdemeanor or Felony Conviction is Expunged, Does That Extinguish an Exclusion Action?
Medicare and Medicaid providers / suppliers are prohibited from employing individuals who have been excluded...
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North Carolina Exclusion Screening Requirements
To understand the North Carolina Exclusion Screening Requirements, we must first touch upon Exclusions...
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What is the NPDB?
I. What is the NPDB The National Practitioner Data Bank (NPDB) was created as part of the Health Care...
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What is the Length of A Mandatory Exclusion?
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) is responsible for...
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What is the Scope of a Mandatory Exclusion Brought Under Section 1128(a)(4) of the Social Security Act (Act)?
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) exercises both mandatory...
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Exclusion Actions Under 42 U.S.C. § 1320a-7(b)(5)(B) -- The Collateral Consequences of a State Medicaid Enrollment Termination Action
Exclusion Actions Under 42 U.S.C. § 1320a-7(b)(5)(B)  (November 2020):  Since 1976, the Department...
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A State Conviction for “Patient Neglect” Will Result in Mandatory Exclusion from Participation in Federal Health Benefit Programs 
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) may be required...
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I Have a Confirmed Exclusion What are my Options
After finding a confirmed exclusion among your employees, vendors, contractors, or volunteers there are...
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Massachusetts Medicaid Exclusion Screening Requirements
Massachusetts Medicaid Exclusion Screening: Requirements and Best Practices for Compliance The Massachusetts...
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Can a Medicare Provider or Supplier Hire an Excluded Individual or Enter in a Contract with an Excluded Entity on the Medicare Exclusion List?
Should you choose to participate in the Medicare and/or Medicaid programs, you must comply with a wide...
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Pennsylvania Doctor Excluded in Connection with Quality of Care
Over the past year, both State and Federal law enforcement investigators and prosecutors have gone to...
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OIG Semiannual Report to Congress: Fall 2018-Spring 2019
The Office of Inspector General (OIG) recently published its Semi-Annual Report to Congress covering...
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Alabama Exclusion Screening Requirements
(May 2, 2019) The Alabama Medicaid Program imposes significant exclusion screening requirements on its...
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New Evidence Shows the Efficiency and Benefits of Using an Internal Compliance Hotline System
(April 4, 2019):  In December of 2018 a study was conducted by Kyle Wench (George Washington University)...
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OIG Enforcement Actions: Notable Decisions from March 2019
(April 2, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG),...
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February Recap of OIG Enforcement Actions: Notable Decisions 
(March 1, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG),...
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What to Know About the New CMS Preclusion List
Beginning April 1, 2019, the new CMS Preclusion List will go into effect subsequently barring many healthcare...
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A Review of OIG Enforcement Actions in Fiscal Year 2018
By Cason Liles (February 6, 2019): The Department of Health and Human Services (HHS), Office of...
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OIG Enforcement Actions: Notable Decisions from January 2019
(February 6, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG),...
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A Provider’s Guide to Texas Medicaid Exclusions: Exclusion Screening Requirements and Best Practices for Compliance
(December 17, 2018):   Texas Medicaid Exclusions will prevent the Texas Medicaid Program from...
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OIG Exclusion Case Study: The Impact of a False Claims Act Judgment.
(August 23, 2018): In 2008, after learning that a Texas-based laboratory services company was submitting...
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Health Care Providers Should Consider the Ramifications of “Taking a Plea” in a Criminal Case or Agreeing to a Licensure Action. It May Trigger a Mandatory or Permissive OIG Exclusion Action.
Perhaps the most severe administrative sanction available under the Social Security Act stems from the...
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Personal Care Service Aides and Attendants Excluded in 2017
(January 22, 2018): With 2017 behind us, it can be quite helpful to review the Medicare “exclusion”...
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Dental OIG Exclusions - A Review of 2017 Actions.
(January 12, 2018):  The Medicare and Medicaid programs are both essential, yet costly health benefit...
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Reciprocal Licensure Actions Can Lead to Medicare Revocation and Exclusion
(January 8, 2018):  Most physicians will progress through their entire career without ever having...
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The Released Year in Review OIG Podcast
Year in Review OIG Podcast Earlier this week, the Office of Inspector General released its “Year in...
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Pain Management Prescribing Practices and Audits
(August 16, 2017): Earlier this summer, the U.S. Department of Justice (DOJ) executed its most extensive...
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Significant Recent Trends in Exclusion Case Settlements
The Office of the Inspector General (OIG) has recently entered into a number of exclusion case settlements tied...
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Health Care Fraud to Remain a DOJ Priority
Exclusion News (May 22, 2017): By Paul Weidenfeld Health Care Fraud will continue to be a high priority...
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The New “Seventh Element” of Compliance: Screening and Evaluating Employee Suitability!
The recently issued Resource Guide for Measuring Compliance Program Effectiveness, reconfigures the traditional...
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Home Health Final Rule Extends Exclusion Screening Obligation: Failure to Screen Could Result in Termination from Medicare
By Paul Weidenfeld The new Final Rule issued by CMS revising the conditions of participation for home...
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Pharmacies Targeted for Exclusion Violations by OIG and States
In what appears to be a growing enforcement trend, the Department of Health and Human Services, Office...
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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...
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OIG Issues Final Rule Expanding Exclusion Authority
By Paul Weidenfeld January 23, 2017 On January 12, 2017, the Office of Inspector General published a...
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DOJ Announces $4.7B in FCA Recoveries: What Does It Mean?
DOJ Announces $4.7 billion in FCA Recoveries By Paul Weidenfeld December 16, 2016 The “Third Best...
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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...
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What Medical Practices Need to Know About OIG Exclusion Screening
[1] The Office of Inspector General (OIG) has steadily increased its enforcement of OIG Exclusion Screening...
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DOJ Doubles Down on False Claims Act Penalties!
  By Robert W. Liles.  August 3, 2016.  The False Claims Act is the primary...
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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)...
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Current States With a Separate Medicaid Exclusion List
How to Apply for OIG Reinstatement
  I. The OIG Reinstatement Process Most exclusions are imposed for a definite time period....
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How Compliance Hotlines Can Save You Money!
By Paul Weidenfeld, March 4, 2016.  An essential element of all compliance plans is developing and...
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2016 OIG Work Plan: State Medicaid Agencies Must Comply with Exclusion Rules
The Office of Inspector General’s 2016 OIG Work Plan contains two important projects that focus...
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Exclusion Loophole: Medicaid Managed Care
In August, we discussed an OIG audit, which revealed that Medicaid providers who were terminated for...
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Who Is to Blame for Gaps in OIG and State Exclusion Lists? What Is the Impact on Providers?
The failure to report excludable offenses by state Medicaid offices and licensing boards is a longstanding...
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Health Care Fraud: Second Conviction Secured in Michigan Excluded Provider Scheme
In February, we reported that the Michigan Attorney General secured a racketeering and health care fraud...
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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)...
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2015 Mid-Year Exclusion Enforcement Action Review
OIG has been busy cracking down on providers who employ or contract with excluded persons or contractors. ...
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Excluded Individual Conducts Elaborate Health Care Fraud Scheme
  The owner of a New Jersey ambulance company was indicted for health care fraud in mid-August of...
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Exclusion Screening Required in United States Territories
Our experts at Exclusion Screening, LLC maintain fact sheets that contain the screening requirements...
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Why Do I Need a Compliance Hotline?
https://www.exclusionscreening.com/wp-content/uploads/2018/06/Why-do-you-need-a-compliance-Hotline.mp4 One...
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Southern District of New York Provides Clarity on “Identifying” Overpayments
In early August of 2015, the Southern District of New York (SDNY) provided insight as to when the...
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Recent Developments on the 60-day Rule and the Potential Impact on Exclusion Violations
The Affordable Care Act (ACA) creates a 60‑day window to report and return overpayments from Medicare...
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Medicaid Providers That Are Excluded or Terminated for Cause Often Continue to Participate in Other States According to a New OIG Audit
  OIG Audit Findings In a recently released audit, the OIG found that despite the ACA requirement...
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DOJ Files Another False Claims Act Case Based on OIG Exclusion Violations
DOJ Pursuing Action on Two Separate OIG Exclusion Violations The U.S. Attorney’s Office in Philadelphia...
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Exclusion Alert: Assistant Inspector General Tells Congress That Exclusion Violations Plague Part D
Assistant Inspector General Testifies before Congress Ann Maxwell, the Assistant Inspector General for...
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OIG Announces Creation of Special Unit for CMP and Exclusion Litigation
 Exclusion Screening, LLC has been chronicling the Office of Inspector General’s (OIG) interest...
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Exclusion Screening of Contractors and Vendors
This article was written by Paul Weidenfeld [1] By now, providers should be aware that the Office of...
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Exclusion Screening Basics for Providers
Exclusion Screening Is Mandatory Providers of medical services that participate in Federal or State Health...
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DOJ Announces New FCA Settlements involving Excluded Persons including a $6.5 Million Settlement involving Services Provided by a Private Duty Nurse Investigated by OIG
The Department of Justice (DOJ) recently announced two new False Claims Act (FCA) settlements involving...
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Exclusion Case Review: 1st Quarter of 2015 Evidences an Increase in Enforcement Efforts by OIG
(This article was originally posted in the National Alliance of Medical Auditing Specialists‘ “Tip...
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HHS/OIG Excludes Illinois Home Health Agency for Exclusion Violation!
Home Health Agency Excluded for Employing Excluded Nurse HHS/OIG recently issued a press release announcing...
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OIG Releases Medicaid Fraud Control Unit (MFCU) Annual Report for FY2014
I.   Gains in State Exclusion Enforcement Efforts Highlighted The Office of the Inspector General’s...
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Medicare and Medicaid Exclusion Screening Compliance: A Challenging Problem with a Surprisingly Simple Solution©
Since August 2014, the Office of Inspector General (OIG) has collected roughly $3.75 Million in...
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OIG's Updated Special Advisory Bulletin on the Effect of Exclusions
The Office of the Inspector General (OIG) Broadly Interprets Exclusion Regulations OIG’s Demonstrated...
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Hospital Enters into False Claims Settlement for Employee with Lapsed License
I.  Hospital Employed Therapist with Lapsed License The Department of Justice (DOJ) entered...
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DC Contractor for Dental Providers Indicted for False Claim
I.  Fraud Found in HHS’ Backyard A Virginia contractor for dental providers was recently indicted...
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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...
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Excluded Podiatrist Convicted of Racketeering and Health Care Fraud
I.  Excluded Podiatrist Commits Health Care Fraud    A Michigan podiatrist who was...
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OIG Issues Advisory Opinion on Exclusions
I.  Advisory Opinion on Payments for Services Provided Prior to Exclusion The Department of Health...
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2014 In Review – OIG Crack Down on Exclusion Violations
I.  CMPs doubled in OIG Exclusion Violations 2014 Exclusion Screening, LLCSM dedicates a significant...
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OIG Trumpets Exclusions, New Actions and Recoveries in its Semi-Annual Report to Congress
I.  OIG Report In the Office of the Inspector General’s (OIG) semiannual report to Congress,...
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Student Loan Default Becoming a Top Reason for Exclusion
Providers are often surprised to learn that a person can be excluded from participation in federal health...
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Why Should I Screen Against Every State Exclusion List?
The Office of the Inspector General (OIG) issued a Special Advisory Bulletin in May 2013, which states...
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Who Should Be on my OIG Exclusion Screening List?
I. Federal and State Agencies Conducting Audits As many healthcare providers and suppliers have painfully...
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Home Health and Nursing Home Facilities a Major Target for OIG Enforcement
I.  Civil Monetary Penalties Twenty-five out of the fifty-five exclusion enforcement actions reported...
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Must Haves for a Proper Exclusion Screening Process
At Exclusion Screening, LLCSM, we know the ins-and-outs of the exclusion screening process. In our opinion,...
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The Administrative Process of Imposing an OIG Exclusion
I.  Mandatory OIG Exclusions When the Office of Inspector General (OIG) considers imposing a mandatory...
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Do I Really Need to Screen My Employees and Vendors Each Month?
I.  OIG Recommends Monthly Screening While there is not a formal regulation that mandates monthly...
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CMP Liabilities: Why Are Some Much Higher Than Others?
[visualizer id=”1978″] A quick review of the Office of Inspector General’s (OIG) exclusion...
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Alert to Florida Providers Regarding Screening
I.  Florida’s State Exclusion. Excluded Providers Costs OIG Over 2.7 Million The Office of...
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Gary Cantrell Testimony: Failures to Report Adverse Licensing Actions Leads to Gaps in the OIG-LEIE
HHS/OIG Deputy Inspector General Gary Cantrell testified earlier this year that States are failing to...
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CMS Finds Fault with Exclusion Information Sharing Between States
I.  Take It from CMS: If You’re Excluded in One State, You’re Excluded in All States Section...
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Exclusion Databases: How Difficult Is Screening and Verifying?
I.  Which Exclusion Databases Do I Need to Screen? The Office of Inspector General (OIG) recommends...
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