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Home Health Agency Excluded for Employing Excluded Nurse HHS/OIG recently issued a press release announcing that it had excluded an Illinois home health agency participation in all Federal health programs as a result of its employment of an excluded nurse. OIG’s investigation revealed that the home care service had billed the Federal health care programs for services provided […]
I. Gains in State Exclusion Enforcement Efforts Highlighted The Office of the Inspector General’s (OIG) annual Report for the State Medicaid Fraud Control Units (MCFUs),1 released earlier this week, announced that one third of all OIG Exclusions (1,337 of 4,017) were the result of MFCU investigations, prosecutions, and convictions. We also note that licensure revocations and patient abuse (both primarily […]
I. GSA-SAM We talk fairly infrequently about the General Service’s Administration’s System for Award Management (GSA-SAM) and thought it was time to address that lapse in information! We know that the Office of the Inspector General has authority to exclude individuals under Section 1128 of the Social Security Act. It is also true that many individuals who […]
I. Hospital Employed Therapist with Lapsed License The Department of Justice (DOJ) entered into a settlement with a nonprofit Michigan hospital this week resolving allegations that the hospital submitted false Medicaid claims. The services had allegedly been rendered by a therapist with a lapsed license. Further, in an unusual move, DOJ required the hospital to acknowledge in the false claims settlement that it […]
I. Fraud Found in HHS’ Backyard A Virginia contractor for dental providers was recently indicted by a grand jury on charges of wire fraud, health care fraud, identity theft and making false statements relating to health care matters. The contractor’s company provided administrative and consulting services to dental practices in and around the Washington, D.C. […]
The Health Care Fraud and Abuse Control Program1 (“HCFAC”) prepares detailed yearly reports which are sometimes viewed to be a barometer of fraud and abuse enforcement efforts. Valid conclusions can’t be drawn based on small samples or on numbers alone. However, side by side comparisons of data or even over a short period of time may be suggestive […]
I. OIG Targets Nursing Homes Last year almost half of the exclusion violation matters reported by the Office of the Inspector General (OIG) involved nursing homes and rehabilitation facilities. This trend is continuing. Last month, the OIG reported five new cases on its website. Three of the five involved nursing homes. A fourth involved a non-profit school […]
I. Excluded Podiatrist Commits Health Care Fraud A Michigan podiatrist who was excluded from participation in the Federal health care programs for a period of 25 years allegedly entered into a health care fraud scheme with another Michigan doctor to perform podiatric services at his clinic. The excluded podiatrist, whose license was also […]
I. Advisory Opinion on Payments for Services Provided Prior to Exclusion The Department of Health and Human Services Office of the Inspector General (OIG) issued an advisory opinion in response to payments received by an excluded provider for services performed prior to the effective date of his or her exclusion.[1] The individual entered a criminal plea and a civil settlement to […]
I. CMPs doubled in 2014 Exclusion Screening, LLCSM dedicates a significant amount of time to examining the Office of the Inspector General’s (OIG) enforcement actions as they relate to exclusion violations. As a broad overview, in 2014 HHS-OIG imposed $10.54 million in Civil Monetary Penalties (CMPs) on providers that “knew or should have known” one or more of […]