OIG Releases Medicaid Fraud Control Unit (MFCU) Annual Report for FY2014
I. Gains in State Exclusion Enforcement Efforts Highlighted The Office of the Inspector General’s (OIG) annual Report for the…
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 MoreOIG Releases Medicaid Fraud Control Unit (MFCU) Annual Report for FY2014
Medicare and Medicaid Exclusion Screening Compliance: A Challenging Problem with a Surprisingly Simple Solution
Since August 2014, the Office of Inspector General (OIG) has collected roughly $3.75 Million in Civil Money Penalties (CMPs)…
OIG’s Updated Special Advisory Bulletin on the Effect of Exclusions
The Office of the Inspector General (OIG) Broadly Interprets Exclusion Regulations OIG’s Demonstrated Interest in Exclusion Screening and…
Hospital Enters into False Claims Settlement for Employee with Lapsed License
I. Hospital Employed Therapist with Lapsed License The Department of Justice (DOJ) entered into a settlement with a nonprofit Michigan…
DC Contractor for Dental Providers Indicted for False Claim
I. Fraud Found in HHS’ Backyard A Virginia contractor for dental providers was recently indicted by a grand…
Review of February, 2014 Exclusion Cases: Focus on Nursing Homes Remains High and the Cost of Violations Rise
I. OIG Targets Nursing Homes Last year almost half of the exclusion violation matters reported by the Office…
Excluded Podiatrist Convicted of Racketeering and Health Care Fraud
I. Excluded Podiatrist Commits Health Care Fraud A Michigan podiatrist who was excluded from participation in the…
OIG Issues Advisory Opinion on Exclusions
I. Advisory Opinion on Payments for Services Provided Prior to Exclusion The Department of Health and Human Services…