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By Robert W. Liles. August 3, 2016. The False Claims Act is the primary civil enforcement tool utilized by the federal government in its fight against fraud generally, and, in particular, Medicare and Medicaid Fraud.[1] Already an extraordinarily useful statute forgovernment prosecutors both in termsof ease of use and in terms of the penalties and damages that may […]
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 […]
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 […]
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 […]
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 […]
By Paul Weidenfeld The Office of Inspector General’s (OIG) 2016 Work Plan contains two important projects that focus on the enforcement of exclusion rules by States and their Medicaid Fraud Control Units. Viewed in the context of the creation of a special task force in June of 2015, and other data we have cited to […]
In August, we discussed an OIG audit, which revealed that Medicaid providers who were terminated for cause were often able to still participate in other state Medicaid programs. Through this audit, OIG discovered that many providers were able to take advantage of a particular exclusion loophole within the Medicaid Managed Care program. Specifically, OIG discovered […]
In February, we reported that the Michigan Attorney General secured a racketeering and health care fraud conviction against an excluded Michigan podiatrist. The podiatrist participated in an elaborate health care fraud scheme with another Michigan provider. In early July, the Michigan Attorney General successfully convicted the doctor who knew or should have known that the […]
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 […]
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 […]