(December 22nd, 2020): The Department of Health and Human Services (HHS), Office of Inspector General (OIG) exercises both mandatory and permissive exclusion authority with respect to Federal health care programs.[1] In a recent New York case, the OIG was required by law to mandatorily exclude an individual for a minimum of five years due to… more>>
Exclusion Actions Under 42 U.S.C. § 1320a-7(b)(5)(B) (November 2020): Since 1976, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) has been at the forefront of our nation’s efforts to fight waste, fraud and abuse in the Medicare, Medicaid and more than 100 other programs. Collectively, the costs of the federal programs… more>>
(January 8, 2018): Most physicians will progress through their entire career without ever having to respond to a complaint or investigation by their State Medical Board. Unfortunately, that isn’t always the case. An average of 4,309 physicians are disciplined each year by state licensure boards around the country.[1] A recent case aptly illustrates how a… more>>
(August 16, 2017): Earlier this summer, the U.S. Department of Justice (DOJ) executed its most extensive “health care fraud takedown” to date, initially arresting 412 licensed healthcare providers, doctors, and nurses alleged to have engaged in fraudulent conduct. As Attorney General Jeff Sessions stated at that time, “We are sending a clear message to criminals… more>>
By Catalina Jandorf The Office of the Inspector General (OIG) has recently entered into a number of exclusion case settlements tied to skilled nursing facilities and hospitals. Additionally, there have been several recent investigations targeted towards physician practices. A rising number of these cases with sizable settlement recoveries highlight an emerging trend to be on the lookout… more>>
By Catalina Jandorf In what appears to be a growing enforcement trend, the Department of Health and Human Services, Office of Inspector General (HHS/OIG) and State Medicaid Fraud Units are aggressively pursuing pharmacy retailers for exclusion violations. In recent investigations, pharmacies are being targeted for failing to screen prescribers as well as employing pharmacists who have been… more>>
Exclusion Violation by Dentist "Sends a Strong Warning" February 1, 2017 By Paul Weidenfeld The Office of the Inspector General's (OIG) announced last week that it had reached a settlement in excess of a million dollars with an excluded dentist for violations of the provisions of the regulations denying participation in federal health care programs… more>>
OIG Imposes Record $21.5 Million in Penalties for Exclusion Violations! The OIG imposed a record $21.5 million civil money penalties and restitution against an Ohio corporation that operates pharmacies and supermarkets in 34 states for exclusion violations involving the employment of excluded individuals and fulfilling prescriptions by excluded prescribers! The settlement alleged that the company filled… more>>
In February, we reported that the Michigan Attorney General secured a racketeering and health care fraud conviction against an excluded Michigan podiatrist. The podiatrist participated in an elaborate health care fraud scheme with another Michigan provider. In early July, the Michigan Attorney General successfully convicted the doctor who knew or should have known that the… more>>
In late July, a federal district court in Pennsylvania joined in the flurry of False Claims Act (FCA) decisions. These decisions further interpreted the ACA’s amendments to the law. The court in United States ex rel. Boise v. Cephalon, Inc. considered two important issues. The issues regarded when a party has an obligation to pay… more>>