Tag: Fraud and Abuse
The Ultimate Guide to Exclusions
This ebook gives an in-depth overview of exclusions and exclusion monitoring.
New DOJ Opioid Fraud and Abuse Detection Unit Created
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.
Lessons Learned from 2017 OIG Semiannual Report to Congress
Each year, the Department of Health and Human Services and OIG is tasked with updating Congress on its performance, trends, and actions taken to combat healthcare fraud and abuse. The mid-term report was issued for the period of October 2016 to March 2017 and describes OIG’s work on identifying significant problems, abuses, deficiencies, remedies, and investigative outcomes relating to the administration of HHS programs and operations that were disclosed during the reporting period.
Medicaid Fraud Control Unit (MFCU) Reporting Accuracy: Then and Now
The Office of Inspector General (OIG) is not the only source for exclusions. Did you know that the state Medicaid agency and/or State Attorney General, if applicable, in each state must report its actions to the Federal OIG promptly after the agency takes a final action? (Social Security Act 1902(a)(41) and 42 CFR 1002.3(b)(3). In this article, we'll take a look at how well reporting has taken place given the latest OIG research data, and compare Q1 2017 results from our latest CHIRP report.
C-Suite and General Counsel Held Liable for Medicaid Fraud
Larger healthcare companies typically employ an entire and robust legal department in-house to handle legal work and provide good counsel to management and senior executives. Some of these companies will hire outside counsel to supplement areas of expertise that may be lacking by an internal department. But what happens when that advice or legal counsel is considered to be fraudulent? Who is liable? Who takes the fall and can be subject to the long arm of the law?
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.