Significant Recent Trends in Exclusion Case Settlements
The Office of the Inspector General (OIG) has recently entered into a number of exclusion case settlements tied to skilled…
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 MoreSignificant Recent Trends in Exclusion Case Settlements
Health Care Fraud to Remain a DOJ Priority
Exclusion News (May 22, 2017):Health Care Fraud will continue to be a high priority of the Department of…
The New “Seventh Element” of Compliance: Screening and Evaluating Employee Suitability!
The recently issued Resource Guide for Measuring Compliance Program Effectiveness, reconfigures the traditional formulation of the “Seven Elements…
Home Health Final Rule Extends Exclusion Screening Obligation: Failure to Screen Could Result in Termination from Medicare
By Paul Weidenfeld The new Final Rule issued by CMS revising the conditions of participation for home health agencies…
Pharmacies Targeted for Exclusion Violations by OIG and States
In what appears to be a growing enforcement trend, the Department of Health and Human Services, Office of…
Excluded Dentist Pays Record $1.1 Million and Agrees to 50 Year Exclusion
Exclusion Violation by Dentist “Sends a Strong Warning” The Office of the Inspector General’s (OIG) announced last week…
OIG Issues Final Rule Expanding Exclusion Authority
On January 12, 2017, the Office of Inspector General published a final rule finalizing revisions to its exclusion…
DOJ Announces $4.7B in FCA Recoveries: What Does It Mean?
DOJ Announces $4.7 billion in FCA Recoveries The “Third Best Year” in False Claims Act History? The Department…