Performance Standard 8(f) states that a Unit should transmit to the federal OIG “reports of all convictions for the purpose of exclusion from Federal health care programs, within 30 days of sentencing.”  The Unit reported their staff erred in failing to follow guidelines and to report convictions and adverse actions within the required time frames.

Further, the OIG found that of the 193 convictions obtained by the Unit half did not report within required time frame (30 days of sentencing) and 10 did report prior to the onsite review.

Of the convictions they did report:florida.png

– 40 were reported within 31-60 days of sentencing
– 17 within 61-90 days of sentencing
– 35 were reported more than 90 days of sentencing

The OIG commented that their concern revolves around the delays causing excluded providers to bill and get reimbursed with improper payments after the sentencing and before they can exclude.

States must do a better job in order for the OIG to do its job in excluding. If the state reports the OIG exclusions within 30 days of sentencing, then the OIG can take proper action to exclude and prevent federal healthcare dollars being paid to providers who should not receive them. It also causes delays in keeping the OIG List of Excluded Individuals and Entities current.  Further, it could cause a problem for an employer if the provider is excluded by the state within 30 days but not reported to the OIG for 90+ days.

You might also enjoy:
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Check out other case studies on MFCU performance:
North to south: MFCU not reporting all OIG exclusions
How well are the medicaid fraud control units doing?

Michael Rosen, Esq.

Written by Michael Rosen, ESQ
ProviderTrust Co-Founder, mrosen@providertrust.com

Michael brings over 20 years of experience founding and leading risk mitigation businesses, receiving numerous accolades such as: Inc Magazine’s Inc 500 Award and Nashville Chamber of Commerce Small Business of the Year
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