Exclusion Screening, LLC has been chronicling the Office of Inspector General’s (OIG) interest in exclusion enforcement for quite some time. Hence, yesterday’s announcement that the OIG created a special litigation unit focusing on Civil Money Penalties (CMP) and Exclusions comes as no surprise to us. Only two weeks ago we published an article on the OIG’s increasing enforcement… more>>
Exclusion Screening Is Mandatory Providers of medical services that participate in Federal or State Health Care Programs are required to screen all of their employees, vendors, and contractors monthly to ensure that none have been excluded from either the Medicare or Medicaid programs. Practices that fail to meet this requirement risk Civil Monetary Penalties (CMPs)… more>>
The Department of Justice (DOJ) recently announced two new False Claims Act (FCA) settlements involving excluded persons. The first was a $6.5 million FCA settlement with a Nashville Home Health Agency. The services of a private duty nurse were identified in both settlement documents and the press release as an important component of the settlement. Although, the exact… more>>
(This article was originally posted in the National Alliance of Medical Auditing Specialists' "Tip of the Week") At Exclusion Screening, we keep track of all of the exclusion cases reported by the OIG and analyze them for any number of obvious reasons. At first glance, the cases reported in the 1st quarter of 2015… more>>
Home Health Agency Excluded for Employing Excluded Nurse HHS/OIG recently issued a press release announcing that it had excluded an Illinois home health agency participation in all Federal health programs as a result of its employment of an excluded nurse. OIG's investigation revealed that the home care service had billed the Federal health care programs for services provided… more>>
I. Gains in State Exclusion Enforcement Efforts Highlighted The Office of the Inspector General's (OIG) annual Report for the State Medicaid Fraud Control Units (MCFUs),1 released earlier this week, announced that one third of all OIG Exclusions (1,337 of 4,017) were the result of MFCU investigations, prosecutions, and convictions. We also note that licensure revocations and patient abuse (both primarily… more>>
I. SAM Exclusion Search We talk fairly infrequently about the General Service’s Administration’s System for Award Management (GSA-SAM) and about SAM Exclusion Search and thought it was time to address that lapse in information! We know that the Office of the Inspector General has authority to exclude individuals under Section 1128 of the Social Security… more>>
I. Hospital Employed Therapist with Lapsed License The Department of Justice (DOJ) entered into a settlement with a nonprofit Michigan hospital this week resolving allegations that the hospital submitted false Medicaid claims. The services had allegedly been rendered by a therapist with a lapsed license. Further, in an unusual move, DOJ required the hospital to acknowledge in the false claims settlement that it… more>>
I. Fraud Found in HHS' Backyard A Virginia contractor for dental providers was recently indicted by a grand jury on charges of wire fraud, health care fraud, identity theft and making false statements relating to health care matters. The contractor’s company provided administrative and consulting services to dental practices in and around the Washington, D.C.… more>>
I. OIG Targets Nursing Homes Last year almost half of the exclusion violation matters reported by the Office of the Inspector General (OIG) involved nursing homes and rehabilitation facilities. This trend is continuing. Last month, the OIG reported five new cases on its website. Three of the five involved nursing homes. A fourth involved a non-profit school… more>>