Map of the States with a Separate Medicaid Exclusion List Click on your state to view their Medicaid exclusion list. Note that the states in grey do not have a separate list. There are a total of 45 separate Medicaid…
Exclusions from participation in federal and state healthcare programs represent a significant and often devastating threat to healthcare providers, especially small practices. These administrative sanctions are designed to protect government programs and beneficiaries by barring individuals and entities who pose…
Being on an exclusion list means that an individual or entity has been barred from participating in a sponsored benefit program, often as a result of a final administrative action taken by Federal or State agencies. This is one of…
This guide helps ensure compliance by verifying that individuals and entities are not excluded from participation in federal healthcare programs (Medicare, Medicaid, etc.) using the OIG’s online lookup tool.
Exclusion monitoring is a mandatory and complex compliance function critical to minimizing liability risks for healthcare providers. The difficulty inherent in the process itself poses the most significant challenges to effective monitoring. 1. The Sheer Volume of Required Databases Providers…
Finding out that an employee, vendor, contractor, or volunteer has a confirmed exclusion is a serious compliance emergency. Since Federal healthcare programs absolutely will not pay for any item or service furnished directly or indirectly by an excluded party, your…
The OIG’s November 2023 Compliance Guidance The OIG’s November 2023 Compliance Guidance lists 7 elements of an effective compliance program. Compliance Hotlines are a critical component of element 4 – “Effective Lines of Communications.” Element 4—Effective Lines of Communication states:…
This article focuses on helping providers understand New York Medicaid exclusion screening law, and its exclusion screening requirements so that they can avoid the risks associated with employing or doing business with excluded parties.
This short question and answer summary will help providers understand and comply Alabama’s exclusion and sanction screening rules and regulations.
We have previously discussed that once a provider is excluded he may not furnish items or services paid for by the the Federal health care programs until he is eligible to apply for reinstatement and the Office of the Inspector General…
What are the California Exclusion List Screening requirements? The Medi-Cal Program will not pay for any item or service furnished directly or indirectly by individuals or entities that have been excluded or suspended from the Medi-Cal Program or that have…
The Pennsylvania Precluded Provider List, commonly referred to as “Pennsylvania Medicheck ,” identifies individuals and entities who have been excluded from participating in the State’s Medicaid Program. It is similar to the OIG’s List of Excluded Individuals and Entities (LEIE)…
Exclusions and debarments are powerful administrative sanctions imposed by Federal and State agencies. They are intended to protect their programs and the beneficiaries they serve by barring the participation of individuals and entities who pose risks to them. Sanctioned parties…
A Provider’s Guide to OIG Exclusions: Federal Exclusion Regulations and Enforcement Authorities, and How Providers Can Avoid Risk with Proper Exclusion Screening This article is an updated version of “A Provider’s Guide to OIG Exclusions: Federal Exclusion Regulations and Enforcement Authorities, and…
OIG Exclusions are powerful enforcement sanctions that bar an individual or entity from any participation in Federal and State health care benefit programs. Programs will not pay for items or services provided by an excluded party, and providers that employ…
The complex web of regulation encompassing government health care dollars is a lot to take on. With 41 state exclusion lists and several federal lists, it can be difficult to know which exclusion lists to screen, let alone actually screen…
After finding a confirmed exclusion among your employees, vendors, contractors, or volunteers there are several options you can take. Each case with a confirmed exclusion is fact-specific, there is no “rubber-stamp” approach to this problem. This article discusses and outlines…
Over the past year, both State and Federal law enforcement investigators and prosecutors have gone to considerable lengths to publicize the government’s fight against opioid abuse. While much of this fight has focused on the manufacturers of prescription opioid products,…
The Office of Inspector General (OIG) recently published its Semi-Annual Report to Congress covering from October 1, 2018 to March 31, 2019. The OIG report focuses on the enforcement actions that were brought and the exclusions that were imposed during…
(May 2, 2019) The Alabama Medicaid Program imposes significant exclusion screening requirements on its providers. Many are unaware of the extent of their exclusion screening obligations or of the severe consequences that can result from a failure to properly screen. This…
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