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The owner of a New Jersey ambulance company was indicted for health care fraud in mid-August of 2015. The owner was excluded from participation in the federal health care programs after being convicted of defrauding New Jersey health care programs in 2003. This is just the latest in a steady stream of health care […]
Our experts at Exclusion Screening, LLC maintain fact sheets that contain the screening requirements for providers in every state, including those states that do not currently maintain a separate excluded or terminated provider list. However, Medicaid participation and adherence to exclusion screening requirements does not stop with the fifty states. United States territories like Puerto […]
The Affordable Care Act (ACA) creates a 60‑day window to report and return overpayments from Medicare or Medicaid after the date on which the overpayments were identified. If the overpayments are not returned within 60 days, then they can become false claims. Though this has been the law since 2010, we are just now seeing how […]
OIG Audit Findings In a recently released audit, the OIG found that despite the ACA requirement that states terminate Medicaid providers already terminated in another state, 12% of providers already terminated for cause in 2011 in one state (295 out of a sample of 2,539) were still participating in other state Medicaid programs as […]
DOJ Pursuing Action on Two Separate OIG Exclusion Violations The U.S. Attorney’s Office in Philadelphia filed a False Claims Act case last week based primarily on OIG exclusion violations. The complaint alleges that the defendant filed several documents concealing his exclusion and his role in Mental Health Clinics ostensibly run by his wife. Medicare and Medicaid […]
Assistant Inspector General Testifies before Congress Ann Maxwell, the Assistant Inspector General for Evaluation and Inspections, recently testified before Congress. She argued that the Centers for Medicare and Medicaid Services (CMS) had not exercised “sufficient oversight of plan sponsors,” and “needed to strengthen its controls” in order to prevent payments for drugs “to providers excluded […]
Exclusion Screening, LLC has been chronicling the Office of Inspector General’s (OIG) interest in exclusion enforcement for quite some time. Hence, yesterday’s announcement that the OIG created a special litigation unit focusing on Civil Money Penalties (CMP) and Exclusions comes as no surprise to us. Only two weeks ago we published an article on the OIG’s increasing […]
Exclusion Screening Is Mandatory Providers of medical services that participate in Federal or State Health Care Programs are required to screen all of their employees, vendors, and contractors monthly to ensure that none have been excluded from either the Medicare or Medicaid programs. Practices that fail to meet this requirement risk Civil Monetary Penalties (CMPs) […]
The Department of Justice (DOJ) recently announced two new False Claims Act (FCA) settlements involving excluded persons. The first was a $6.5 million FCA settlement with a Nashville Home Health Agency. The services of a private duty nurse were identified in both settlement documents and the press release as an important component of the settlement. Although, the exact […]
(This article was originally posted in the National Alliance of Medical Auditing Specialists‘ “Tip of the Week”) At Exclusion Screening, we keep track of all of the exclusion cases reported by the OIG and analyze them for any number of obvious reasons. At first glance, the cases reported in the 1st quarter of 2015 […]