Author: Donna Thiel
Do you have the resources; time and or people? Do you have the expertise? Do you have an internal audit team or are you using contract auditors? How often should you audit? What do you do with the audit findings? I am tired already, and we haven’t even gotten started. *Updated from original post on 11/15/2016
Throughout the year, the Office of Inspector General (OIG), as well as the Department of Justice (DOJ) and President Trump, have made it clear that opioid abuse is a primary area of focus for government agencies. In a recent announcement, Attorney General Sessions showed that the government isn’t just talking- they are taking action. On August 2nd, Attorney General Sessions announced the formation of the Opioid Fraud and Abuse Detection Unit. This new unit of the DOJ will be a pilot program to utilize data to help combat the opioid crisis.
On June 30, the Center for Clinical Standards and Quality/Survey & Certification Group issued a memorandum outlining revisions to the State Operations Manual (SOM) Appendix PP for Phase 2, F-Tag revisions, and several other related issues specific to the Requirements of Participation of nursing centers. The new CMS mandates include the minimum health and safety standards that skilled nursing facilities must meet to participate in Medicare and Medicaid.
New Mexico’s Attorney General Hector Balderas takes Medicaid fraud very seriously, and late last week announced several new initiatives to weed out Medicaid fraud in his state. For the first time in New Mexico’s history, the Attorney General has requested and received a waiver from the federal government to allow the Office of the Attorney General to proactively search through data to identify patterns of fraud.
Like most compliance officers, I receive compliance updates in my inbox every day from various vendors, compliance organizations, and of course the Office of Inspector General and Department of Justice. I always make sure to read all of the recent government settlements but maybe because of my background and love for the post-acute sector, I continue to notice how frequently the OIG and DOJ focus on the post-acute sector, and often more specifically on skilled nursing facilities.
You found an excluded employee in your organization, now what? Likely, your first thought is a bit of panic and a lot of questions. How long has this person worked for us? How did we miss this? What position did they hold? Did we receive federal funds for the job this person held? What do I do now? If there is any good news in this scenario, perhaps it is that the Office of Inspector General (OIG) has given providers direction on how to prepare for a self-disclosure to the OIG via the OIG’s Provider Self-Disclosure Protocol (SDP) document.
Let’s take a stroll down memory lane. Do you remember when you were the new compliance officer in your organization? Maybe you were reviewing all of the compliance processes and trying to determine what was working well and where things might need a little improvement? At some point, if you’re like me, you began to review the exclusion monitoring process and quickly realized you need some help.
Compliance moves fast these days, with all of us wanting information at our fingertips. As a former Chief Compliance Officer of a very large post-acute care company, I know how much data is available and how difficult it can be to turn that data into something useful or meaningful.
It is National Acoustic Neuroma Awareness Week, who knew? Most people have probably never heard of National Acoustic Neuroma Awareness Week let alone know what an Acoustic Neuroma is, but this is a subject near and dear to my heart. So I decided I should do my part to raise awareness too.
Six months ago, I made the decision to make a huge career change and leave the comfort of a 30-year business relationship and join the ProviderTrust team.
On Monday, April 24th, Attorney General Jeff Sessions addressed participants at the Ethics and Compliance Institute (ECI) Annual Conference and shared some important messages with compliance professionals.
As we all know, Corporate Integrity Agreements (CIA’s) are an excellent resource to a compliance officer when trying to stay ahead of the ever-changing compliance landscape. CIA’s provide a wealth of information as to what the Office of Inspector General (OIG) believes should be elements of an effective compliance program. They can also help clarify roles and responsibilities of the board or senior leadership in a healthcare organization. It is highly recommended that you monitor CIAs posted on the OIG site on a periodic basis to see if the model CIA has been updated or changed.