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State Medicaid Agencies Still Challenged with Determining When to Implement Payment Suspensions
State Medicaid Agencies Still Challenged with Determining When to Implement Payment Suspensions

Using payment suspensions, when appropriate, is important to protect Medicaid funds: payment suspensions based on credible allegations of fraud can swiftly stop the flow of Medicaid dollars to providers defrauding Medicaid. A payment suspension can remain in place throughout a law enforcement investigation and potential prosecution of a healthcare fraud case.

CMS Helps Ease Restrictions During Hurricane Harvey Recovery
CMS Helps Ease Restrictions During Hurricane Harvey Recovery

There’s no doubt it will take quite some time to fully understand the scope of damage done in the aftermath of Hurricane Harvey. So many individuals have felt the force of this disaster, and sometimes the most vulnerable victims are the ones who rely on healthcare for their most basic everyday needs. Last week, the Centers for Medicare & Medicaid Services responded to this dilemma in a statement that explains some of the actions being taken to address serious concerns during the recovery process.

ProviderTrust Honored on Inc. 5000 List for Second Consecutive Year
ProviderTrust Honored on Inc. 5000 List for Second Consecutive Year

We are ecstatic to be honored for the second consecutive year on the 2017 Inc. 5000 list as one of the fastest-growing private companies in America. At ProviderTrust, we are always challenging ourselves to be engaged in the healthcare community, and are driven by providing simple solutions for compliance and HR professionals. Take a look at our story and see where we’ve come from to know where we are going in the future.

New DOJ Opioid Fraud and Abuse Detection Unit Created
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
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.

OIG Focuses on Combatting Home Health Fraud and Neglect
OIG Focuses on Combatting Home Health Fraud and Neglect

Ohio had their hands full in a federal case involving a former home healthcare nurse who committed heinous crimes and Medicaid fraud involving a severely physically disabled 14-year-old minor (cerebral palsy) in her care. As a result of her neglect and fraud, she also received a lifetime ban from working in any governmental entity in the healthcare field.

New Mexico Takes Aim at Medicaid Fraud and Abuse
New Mexico Takes Aim at Medicaid Fraud and Abuse

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.

Medicaid Fraud Control Unit (MFCU) Reporting Accuracy: Then and Now
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
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?

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