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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 […]
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 […]
Compliance Hotlines Can Save Money! By Paul Weidenfeld, March 4, 2016. An essential element of all compliance plans is developing and promoting “effective lines of communications.” In support of that element, Health and Human Services Office of Inspector General (HHS/OIG) has been urging providers to adopt anonymous hotlines since 1998. CMS, on the other hand, […]
The failure to report excludable offenses by state Medicaid offices and licensing boards is a longstanding issue for the OIG. Recent OIG audits and reports have confirmed these state failures to report. For example, an OIG study released in August found that over 12% of terminated providers were able to continue participating in other […]
In early August of 2015, the Southern District of New York (SDNY) provided insight as to when the 60-day clock for returning an overpayment begins to run under the Patient Protection and Affordable Care Act of 2010 (ACA). This decision is particularly relevant to screening for exclusions because the government has started to penalize providers who […]
Exclusion Screening of Contractors and Vendors By now, providers should be aware that the Office of Inspector General (OIG) requires exclusion screening of contractors and vendors, in addition to employees, if they provide items or services that are payable by Federal health care programs. This article identifies the OIG’s guidance on the issue, explains the […]
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) […]
Since August 2014, the Office of Inspector General (OIG) has collected roughly $3.75 Million in Civil Money Penalties (CMPs) in cases involving the employment of persons that have been “excluded” from Medicare. This amount exceeds the total CMPs assessed by OIG on this issue in all of 2013. This continues an established trend. The number of exclusion […]
The Office of the Inspector General (OIG) Broadly Interprets Exclusion Regulations OIG’s Demonstrated Interest in Exclusion Screening and Forewarning of Increased Enforcement Efforts By Paul Weidenfeld The OIG’s Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs[1] explains the types of conduct that could violate the payment prohibition, which regards items or services provided […]
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 […]