A Provider’s Guide to Texas Medicaid Exclusions: Exclusion Screening Requirements and Best Practices for Compliance
Texas Health and Human Services Commission OIG maintains the Texas OIG Exclusion Search — a separate Medicaid exclusion…
Category Exclusion Screening
Exclusion screening is the federal and state compliance obligation to verify that healthcare employees, vendors, and contractors are not barred from participating in Medicare, Medicaid, or other federally-funded programs. Every healthcare provider that bills a federal program is required to screen upon hire and monthly thereafter against the OIG LEIE, GSA/SAM, and all 44 state Medicaid exclusion lists. Failure to screen exposes providers to civil money penalties of up to $24,947 per violation, overpayment liability, and potential False Claims Act exposure. This section of the site is the definitive hub for exclusion screening compliance: the pillar guides, state-by-state requirements, enforcement trends, and the regulatory framework explained by the former federal prosecutors who built it.
Read MoreA Provider’s Guide to Texas Medicaid Exclusions: Exclusion Screening Requirements and Best Practices for Compliance
OIG Exclusion Case Study: The Impact of a False Claims Act Judgment.
(August 23, 2018): In 2008, after learning that a Texas-based laboratory services company was submitting false claims to…
Health Care Providers Should Consider the Ramifications of “Taking a Plea” in a Criminal Case or Agreeing to a Licensure Action. It May Trigger a Mandatory or Permissive OIG Exclusion Action.
Perhaps the most severe administrative sanction available under the Social Security Act stems from the authority of the…
Personal Care Service Aides and Attendants Excluded in 2017
(January 22, 2018): With 2017 behind us, it can be quite helpful to review the Medicare “exclusion” actions taken…
Dental OIG Exclusions – A Review of 2017 Actions.
(January 12, 2018): The Medicare and Medicaid programs are both essential, yet costly health benefit programs sponsored in…
Reciprocal Licensure Actions Can Lead to Medicare Revocation and Exclusion
(January 8, 2018): Most physicians will progress through their entire career without ever having to respond to a…
The Released Year in Review OIG Podcast
Year in Review OIG Podcast Earlier this week, the Office of Inspector General released its “Year in Review”…
Pain Management Prescribing Practices and Audits
(August 16, 2017): Earlier this summer, the U.S. Department of Justice (DOJ) executed its most extensive “health care…