Since the CMS Preclusion list was announced in April 2018, and then published in January 2019, there has been confusion and questions regarding the list, its differences from the OIG Exclusion List, the size of the list, and who has access. Unfortunately, the publication of the list has added further complexity to the already complicated… more>>
Once you understand why you must screen for excluded providers via the OIG LEIE, the first step is the most simple, you must go to the “Search Exclusions Database” page on the Office of Inspector General Health and Human Services (OIG HHS) website. That page can be found at the following link; https://exclusions.oig.hhs.gov.Before we begin,… more>>
Why is it Necessary to Screen Against the NPPES Registry? (December 7th, 2020): We are sometimes asked “Why do you screen against the National Plan and Provider Enumeration System (NPPES).” That is a great question. Many health care providers are only familiar with the exclusion database maintained by the Department of Health and Human Services (HHS),… more>>
(January 12, 2018): The Medicare and Medicaid programs are both essential, yet costly health benefit programs sponsored in whole or in part by the Federal government. With Medicare and Medicaid costing $686 and $368 billion each year, respectively, the government has dedicated experienced investigators, auditors and prosecutors to ferret out incidents of health care fraud and… more>>
Year in Review OIG Podcast Earlier this week, the Office of Inspector General released its “Year in Review” OIG Podcast highlighting the OIG’s major accomplishments for 2017. The OIG podcast reported 881 criminal actions, 826 civil actions and over $4 billion in recoveries. OIG also excluded 3,244 from participating in federal health care programs during… more>>
Is Your Practice Being Audited by a ZPIC? Did You Know it Can Lead to an OIG Exclusion?Zone Program Integrity Contractors (ZPICs) are among the most aggressive program integrity entities employed by the Centers for Medicare and Medicaid Services (CMS). As most healthcare providers are aware, ZPICs regularly place physician practices on prepayment review and… more>>
The recently issued Resource Guide for Measuring Compliance Program Effectiveness, reconfigures the traditional formulation of the “Seven Elements of an Effective Compliance Program by making the “Screening and Evaluation of Employees, Physicians, Vendors and other Agents” an element unto itself – or the new “Seventh Element of Compliance!” The Resource Guide, a product of roundtable discussions… more>>
By Paul Weidenfeld January 23, 2017 On January 12, 2017, the Office of Inspector General published a final rule finalizing revisions to its exclusion authorities. The final rule makes changes to key definitions that could have a significant impact on providers by broadening the scope of their exclusion screening obligation and enhancing exclusion enforcement by… more>>
By Paul Weidenfeld [1] The Office of Inspector General (OIG) has steadily increased its enforcement of OIG Exclusion Screening violations since the issuance of its Special Advisory stressing the effect of an OIG Exclusion in May, 2013. Among other things, they have created a special unit to focus specifically on Civil Money Penalties (CMPs) (its favored enforcement tool), supported… more>>
On April 18, 2016, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) issued updated criteria for assessing and evaluating the imposition of permissive exclusions under Section 1128(b)(7) of the Social Security Act. The update replaces the 1997 Federal Register notice and demonstrates the OIG’s ongoing interest in the implementation and enforcement… more>>