OIG Enforcement Actions: Notable Decisions from March 2019
(April 2, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG), has continued its goal of enforcing its guidelines and rules upon medical providers participating in their programs. The OIG has kept pursuing its goal of protecting the integrity of its federal health care programs and their respective patients. Several notable cases in which the OIG found inaccuracies or fraud are highlighted below:
(March 1, 2019). A Skilled Nursing Facility located in Tennessee Settled a Case Involving Excluded Individual
On March 1, 2019, a Health Care Center located in Jackson, Tennessee, was forced to enter into a $81,419.42 settlement agreement with OIG. This pricey agreement resolved any accusations that the Skilled Nursing facility had hired an individual who was on the exclusions list meaning they are excluded from participating in any Federal health care program. The OIG investigation revealed that the excluded individual, a registered nurse, provided items or services to the facilities patients that were billed to Federal health care programs.
(March 8, 2019). Oklahoma Skilled Nursing Facility Settles Case Involving Excluded Individual
On March 8, 2019, a Nursing and Rehabilitation facility located in Cleveland, Oklahoma, was forced to enter into a $171,047 settlement agreement with OIG. The settlement agreement put to rest allegations that the Skilled Nursing facility employed an excluded individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, an office manager, provided items or services to patients that were billed to Federal health care programs. This should serve as a reminder that you need to screen ALL of your employees!
(March 13, 2019). A Medical Group out of Kentucky has Been Found in Violation of the False Claims Act.
On March 13, 2019, a Medical group located in Louisville, Kentucky, was found in violation of the False Claims Act. As a result they entered into a $69,776.24 settlement agreement with OIG. The settlement agreement resolves allegations that the group had submitted false claims to Medicare for specimen validity testing (SVT), a non-covered service.
(March 13, 2019). A Kentucky Lab has Been Found in Violation of the False Claims Act.
On March 13, 2019, a Medical Lab located in Louisville, Kentucky, entered into a $125,983.16 settlement agreement with OIG. The settlement agreement resolves allegations that the lab submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. These last two enforcement actions show that the OIG is beginning a trend of auditing and investigating Medical Labs.
Concluding Thoughts
During the month of March, the OIG continued to take action against providers that have failed to perform their mandatory exclusion screening obligations. We here at Exclusion Screening have taken all of the guesswork out of these duties. Call us up for a no-obligation quote. You will be glad you did. We can be reach at: info@exclusionscreening.com or by phone, 800-294-0952.