2016 OIG Work Plan: State Medicaid Agencies Must Comply with Exclusion Rules
I. The Projects of 2016 OIG Work Plan In the first project, the OIG announced that it will…
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 More2016 OIG Work Plan: State Medicaid Agencies Must Comply with Exclusion Rules
OIG Imposes Record Penalties for Exclusion Violations
OIG Imposes Record $21.5 Million in Penalties for Exclusion Violations! The OIG imposed a record $21.5 million civil…
What Medical Practices Need to Know About OIG Exclusion Screening
[1] The Office of Inspector General (OIG) has steadily increased its enforcement of OIG Exclusion Screening violations since the…
DOJ Doubles Down on False Claims Act Penalties!
The False Claims Act is the primary civil enforcement tool utilized by the federal government in its fight against fraud…
OIG Issues Updated Criteria for Implementing Its Permissive Exclusion Authority
On April 18, 2016, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) issued updated…
How to Apply for OIG Reinstatement
I. The OIG Reinstatement Process Most exclusions are imposed for a definite time period. The question for an…
Exclusion Loophole: Medicaid Managed Care
In August, we discussed an OIG audit, which revealed that Medicaid providers who were terminated for cause were…
Who Is to Blame for Gaps in OIG and State Exclusion Lists? What Is the Impact on Providers?
The failure to report excludable offenses by state Medicaid offices and licensing boards is a longstanding issue for…