CMS Announces Higher Compliance Standards for Provider Enrollment
As CMS releases the final rule around Program Integrity Enhancements to the Provider Enrollment Process, prepare for new affiliations and disclosure requirements.
Tag: Exclusions
The Ultimate Guide to Exclusions
Learn about the OIG and the risks of doing business with an excluded provider and how to avoid those fines.
The Differences Between the OIG-LEIE and SAM/GSA Exclusion List
The OIG exclusion list databases in the healthcare compliance industry need to be cross-checked and cross-referenced in order to remain compliant. This can be overwhelming at times, especially when it comes to understanding the difference between the lists. However, there are big differences between the OIG-LEIE and the GSA exclusion list, and most of the differences have to do with the power of the hammer and the ease of use of the data.
GSA Exclusion List: What Happened to It?
For years the General Services Administration (GSA), is the Federal agency that issues Federal contracts. The GSA exclusion list issues contracts through a competitive bid process for companies that want to conduct business with the Federal government.
The ABC’s of OIG Exclusion List Monitoring
* Updated from original post on 12/17/2015 Healthcare compliance is complicated and full of regulations, guidelines, and oversight. Since federal tax dollars are used to reimburse health care providers for services, the Department of Health and Human Services (HHS) as well as the Department of Justice (DOJ) have oversight on how those dollars are spent. The purpose of this blog post is to give a basic understanding of exclusions, industry best practices, and a brief description of the federal exclusion databases.
States with the Most Excluded Parties
Which states have the most exclusions? Glad you asked! First off, did you know that there are 40 states that have a state Medicaid exclusion list in addition to the two federal exclusion datasources (OIG-LEIE and SAM.gov)? Did you also know that a state Attorney General’s Office and/or Medicaid Agency can impose an exclusion on a person or entity in addition to the OIG? In today’s compliance environment, it’s important to have a comprehensive monitoring program that is placing just as much emphasis at the state level to achieve 100% compliance.
The Complexities of Exclusion Monitoring
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.
The Path of an OIG Exclusion
Maybe the Wizard of Oz had good advice: follow the yellow brick road. It may have curves and present different paths, and you may meet some interesting people along the way, but in the end, it can take you to the big castle. In this case, the castle is the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) - the ultimate enforcer for healthcare fraud. The OIG has enforcement powers with the wave of its wand. Those powers include the statutory authority to impose civil fines and penalties (CMP) and exclusions against individuals and/or entities that stray from the yellow brick road.
Student Loan Crisis: Exclusions Issued for Defaulting on Loans
As a nation we're facing a serious student loan crisis. Whether you paid off your loans years ago, continue to pay them off now, or helping your children or grandchildren with their share of loans, we've all encountered the massive amounts of student debt piling up.
Quick Guide to Exclusion Searches : LEIE
Exclusion is a word we hear often in our line of work, but it can become pretty convoluted with multiple interpretations, definitions, and technicalities that could make your head spin. Many times, compliance professionals don't recognize where to search, what to look for, or how often they should be monitoring for exclusions. For starters, let’s take a look at how to perform a quick exclusion search via the OIG LEIE. It is the most reliable source for searching for possible excluded indiviudals or entities.
When a Five Year Exclusion Became Fifteen
What’s the expression - if at first you don’t succeed, try, try, and try again? One way to continue to be on the OIG list of bad actors is to get caught, become excluded, and continue to bill Medicare.
Mother and Son Conspire to Defraud Medicaid
Does it matter whose license is used to bill CMS for services? Don’t ask these moms - they don’t know best!