Health Care Fraud: Second Conviction Secured in Michigan Excluded Provider Scheme
In February, we reported that the Michigan Attorney General secured a racketeering and health care fraud conviction against…
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 MoreHealth Care Fraud: Second Conviction Secured in Michigan Excluded Provider Scheme
Pennsylvania Judge Holds that CIA violations May Result in FCA Liability
In late July, a federal district court in Pennsylvania joined in the flurry of False Claims Act (FCA) decisions.…
2015 Mid-Year Exclusion Enforcement Action Review
OIG has been busy cracking down on providers who employ or contract with excluded persons or contractors. In…
Excluded Individual Conducts Elaborate Health Care Fraud Scheme
The owner of a New Jersey ambulance company was indicted for health care fraud in mid-August of 2015.…
Exclusion Screening Required in United States Territories
Our experts at Exclusion Screening, LLC maintain fact sheets that contain the screening requirements for providers in every…
Southern District of New York Provides Clarity on “Identifying” Overpayments
In early August of 2015, the Southern District of New York (SDNY) provided insight as to when the 60-day…
Recent Developments on the 60-day Rule and the Potential Impact on Exclusion Violations
The Affordable Care Act (ACA) creates a 60‑day window to report and return overpayments from Medicare or Medicaid…
Medicaid Providers That Are Excluded or Terminated for Cause Often Continue to Participate in Other States According to a New OIG Audit
OIG Audit Findings In a recently released audit, the OIG found that despite the ACA requirement that…