We are sometimes asked, “Why do you screen against the National Plan and Provider Enumeration System (NPPES).” That is a great question. Many healthcare providers are only familiar with the exclusion database maintained by the Department of Health and Human…
Since the CMS Preclusion list was announced in April 2018, and then published in January 2019, there has been confusion and questions regarding the list, its differences from the OIG Exclusion List, the size of the list, and who has…
Health care providers and suppliers should also screen the General Services Administration’s (GSA’s) System for Award Management (SAM) database to ensure that the individuals and entities they employ or do business with have not been suspended or debarred from doing business with certain federal agencies and the programs they administer.
California’s Medi-Cal Suspended and Ineligible Provider List is Designed to Safeguard Beneficiaries and Protect the Financial Integrity of the Medi-Cal Program. Most healthcare providers and suppliers in the State of California are aware that exclusions imposed by the Department of…
At Exclusion Screening, we often receive questions about the scope and frequency of an organization’s screening duties and responsibilities. One question in particular that we are regularly asked is whether an organization has an affirmative obligation to screen employees, agents,…
I. Introduction The Office of Inspector General (OIG) has the authority to exclude providers from participating in federal health care programs[i] and to impose civil money penalties (CMPs) for breaches of exclusion regulations.[ii] Since funds received by a provider in…
The last two years have been rough for everyone, and it has been particularly difficult for health care providers and suppliers. For example, the rapid spread of the Covid Omicron variant not only threatened to overwhelm a health care system…
The Centers for Medicare and Medicaid Services (CMS)[1] is the Federal agency tasked with the overall responsibility of managing the Medicare program. Thus, while the Office of Inspector General (OIG) is the primary agency responsible for protecting the integrity of…
Medicare and Medicaid providers / suppliers are prohibited from employing individuals who have been excluded from participation in Federal health care benefits programs. Similarly, participating providers and suppliers are also obligated to ensure that any business affiliates (such as vendors,…
To understand the North Carolina Exclusion Screening Requirements, we must first touch upon Exclusions in general. Office of Inspector General (OIG) exclusions are one of the most powerful weapons available to the law enforcement in its efforts to fight healthcare…
I. What is the NPDB The National Practitioner Data Bank (NPDB) was created as part of the Health Care Quality Improvement Act of 1986 (HCQIA). This legislation was intended, in part, to establish a database of medical malpractice payments, State…
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) is responsible for overseeing the financial and program integrity of more than 100 HHS programs, one of which is the Medicare program. As you would imagine, the…
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) exercises both mandatory and permissive exclusion authority with respect to Federal health care programs.[1] In a recent New York case, the OIG was required by law to…
Exclusion Actions Under 42 U.S.C. § 1320a-7(b)(5)(B) (November 2020): Since 1976, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) has been at the forefront of our nation’s efforts to fight waste, fraud and abuse in…
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) may be required by law under Section 1128 of the Social Security Act to exclude individuals and entities from participating in Federal health care benefits programs if…
Massachusetts Medicaid Exclusion Screening: Requirements and Best Practices for Compliance The Massachusetts Medicaid Exclusion requirements, under MassHealth, will not reimburse any item or service furnished directly or indirectly by individuals or entities that have been excluded from any State or…
Should you choose to participate in the Medicare and/or Medicaid programs, you must comply with a wide variety of program integrity requirements. One obligation, in particular, is often missed by physician practices, home health agencies, hospices, and laboratories – the…
By Cason Liles (February 6, 2019): The Department of Health and Human Services (HHS), Office of Inspector General (OIG) is an independent, objective law enforcement and investigative agency that is responsible for protecting the financial integrity of the more than 300…
(December 17, 2018): Texas Medicaid Exclusions will prevent the Texas Medicaid Program from paying for any item or service furnished directly or indirectly by individuals or entities that have been excluded from a State or Federal health care program. This…
(August 23, 2018): In 2008, after learning that a Texas-based laboratory services company was submitting false claims to the Medicare program, a private citizen filed suit, on behalf of the United States, against the laboratory services company under the qui…
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