Learn how to screen your non-employed provider populations (referring, ordering, prescribing physicians with NPI verification and ongoing sanction/exclusion monitoring.
Learn how HHS OIG makes a decision on when to impose permissive exclusions for healthcare providers, managing employees, owners, vendors, and more.
As CMS releases the final rule around Program Integrity Enhancements to the Provider Enrollment Process, prepare for new affiliations and disclosure requirements.
Learn the main differences between the SAM / GSA's healthcare exclusion list and the HHS OIG's List of Excluded Individuals and Entities (LEIE).
Optimize your healthcare compliance program with comprehensive provider monitoring including vendors, owners, managers, third parties, and more.
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.
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.
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.
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.
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.