(April 4, 2019): In December of 2018 a study was conducted by Kyle Wench (George Washington University) and Stephen Stubben (University of Utah) to examine the use and extent of internal whistleblower hotline systems within publicly traded organizations. This study…
(April 2, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG), has continued its goal of enforcing its guidelines and rules upon medical providers participating in their programs. The OIG has kept pursuing its goal…
(March 1, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG), has continued its goal of enforcing its guidelines and rules upon medical providers participating in their programs. The OIG has kept pursuing its goal…
Beginning April 1, 2019, the new CMS Preclusion List will go into effect subsequently barring many healthcare professionals from receiving payment for Medicare Advantage (MA) items and services or Part D drugs furnished or prescribed to Medicare beneficiaries. But what…
(February 6, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG), didn’t skip a beat ringing in the new year. The OIG kept pursuing its goal of protecting the integrity of its federal health care…
Year in Review OIG Podcast Earlier this week, the Office of Inspector General released its “Year in Review” OIG Podcast highlighting the OIG’s major accomplishments for 2017. The OIG podcast reported 881 criminal actions, 826 civil actions and over $4…
The Office of the Inspector General (OIG) has recently entered into a number of exclusion case settlements tied to skilled nursing facilities and hospitals. Additionally, there have been several recent investigations targeted towards physician practices. A rising number of these cases with…
Exclusion News (May 22, 2017):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” –…
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…
By Paul Weidenfeld The new Final Rule issued by CMS revising the conditions of participation for home health agencies (HHAs) requires that providers “must ensure” that agencies providing services under arrangement have not been excluded from Medicare, Medicaid or any other…
In what appears to be a growing enforcement trend, the Department of Health and Human Services, Office of Inspector General (HHS/OIG) and State Medicaid Fraud Units are aggressively pursuing pharmacy retailers for exclusion violations. In recent investigations, pharmacies are being targeted…
Exclusion Violation by Dentist “Sends a Strong Warning” 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…
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…
DOJ Announces $4.7 billion in FCA Recoveries 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…
I. The Projects of 2016 OIG Work Plan In the first project, the OIG announced that it will determine the extent to which States are collecting the required ownership information in compliance with Federal and State regulations and whether States…
OIG Imposes Record $21.5 Million in Penalties for Exclusion Violations! The OIG imposed a record $21.5 million civil money penalties and restitution against an Ohio corporation that operates pharmacies and supermarkets in 34 states for exclusion violations involving the employment of…
[1] The Office of Inspector General (OIG) has steadily increased its enforcement of OIG Exclusion Screening 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…
On April 18, 2016, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) issued updated criteria for assessing and evaluating the imposition of permissive exclusions under Section 1128(b)(7) of the Social Security Act. The update replaces the…
I. The OIG Reinstatement Process Most exclusions are imposed for a definite time period. The question for an excluded individual or entity is: What happens at the end of the exclusion period? The answer is that the excluded individual or…
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…
Talk with exclusion screening experts
