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By Robert Liles (January 5, 2018): Does your health care organization have a compliance hotline / fraud hotline in place? If not, it should implement one as soon as possible. As proof positive that hotlines are effective you only have to check out the most recent hotline activity reported by the Department of Health and […]
(August 16, 2017): Earlier this summer, the U.S. Department of Justice (DOJ) executed its most extensive “health care fraud takedown” to date, initially arresting 412 licensed healthcare providers, doctors, and nurses alleged to have engaged in fraudulent conduct. As Attorney General Jeff Sessions stated at that time, “We are sending a clear message to criminals […]
By Robert Liles Have you implemented the new “ Advance Beneficiary Notice of Noncoverage ” (ABN), required by the Centers for Medicare and Medicaid Services (CMS)? As CMS has noted, although the latest version of the form (ABN Form CMS-R-131) does not include any substantive changes, in accordance with Section 504 of the Rehabilitation Act of 1973, […]
Exclusion News (May 22, 2017): By Paul Weidenfeld Health Care Fraud will continue to be a high priority of the Department of Justice Kenneth Blanco, the Acting Head of the Criminal Division. Describing health care fraud as “egregious,” “despicable” and driven by “greed” – Mr. Blanco, told the iABA Health Care Fraud Institute last week. […]
The recently issued Resource Guide for Measuring Compliance Program Effectiveness, reconfigures the traditional formulation of the “Seven Elements of an Effective Compliance Program by making the “Screening and Evaluation of Employees, Physicians, Vendors and other Agents” an element unto itself – or the new “Seventh Element of Compliance!” The Resource Guide, a product of roundtable discussions […]
Exclusion Violation by Dentist "Sends a Strong Warning" February 1, 2017 By Paul Weidenfeld The Office of the Inspector General's (OIG) announced last week that it had reached a settlement in excess of a million dollars with an excluded dentist for violations of the provisions of the regulations denying participation in federal health care programs […]
By Paul Weidenfeld January 23, 2017 On January 12, 2017, the Office of Inspector General published a final rule finalizing revisions to its exclusion authorities. The final rule makes changes to key definitions that could have a significant impact on providers by broadening the scope of their exclusion screening obligation and enhancing exclusion enforcement by […]
DOJ Announces $4.7 billion in False Claims Act Recoveries By Paul Weidenfeld December 16, 2016 The “Third Best Year” in False Claims Act History? The Department of Justice announced earlier this week that FY 2016 was its third best year in “False Claims Act History” with recoveries of more than $4.7 billion in settlements and judgments. […]
Enforcement of exclusion violations by the Office of the Inspector General (OIG) continues to show rise with increases in both the number of cases and the size of the settlement recoveries over the first part of the year. As always, this is a trend that we will continue to keep track of. I. Imposition of […]
By Paul Weidenfeld [1] The Office of Inspector General (OIG) has steadily increased its enforcement of OIG Exclusion violations since the issuance of its Special Advisory stressing the effect of an OIG Exclusion in May, 2013. Among other things, they have created a special unit to focus specifically on Civil Money Penalties (CMPs) (its favored enforcement tool), supported numerous prosecutions […]