Tag: Industry News
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.
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.
August is packed with news and insights from many healthcare compliance resources. We’ve curated recent articles that stood out in our eyes this month. Our list includes stories and releases from OIG and CMS, as well as blogs concerning regulation uncertainty and new challenges providers are facing. Take a look!
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.
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.
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.
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’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.
The Chicago U.S. Attorney's Office is creating a new unit to prosecute healthcare fraud. Assistant U.S. Attorney Heather McShain will lead the team of five prosecutors. The team brings local focus on combatting fraud in Medicare, which has been a national priority for the U.S. Department of Justice (DOJ) for nearly a decade.
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.
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?
Have you heard of the OIG’s Work Plan? Effective June 15, The OIG announced that it will update its Work Plan website monthly and provide more timely information. Usually, compliance professionals have been accustomed to receiving annual OIG Work Plans between August and October, and possibly an update once a year on the progress. Let’s take a look at some of the new features and content.
Did you know that according to the OIG, when your exclusion is “over” not everyone is automatically “cleared” at the end of the exclusion period? Instead, the provider must apply through the OIG for reinstatement. Many times, this assumption can really hurt providers when they come to realize that they are still on the OIG exclusion list years later.
This year’s American Bar Association’s 27th Annual Institute on Health Care Fraud featured Acting Assistant Attorney General Kenneth Blanco, of the Criminal Division of the Department of Justice (DOJ). Mr. Blanco reiterated Attorney General Jeff Sessions’ commitment to ferreting and fighting fraud and abuse.