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The Differences Between the OIG-LEIE and SAM/GSA Exclusion List
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. 

The ABC’s of OIG Exclusion List Monitoring
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.

The Path of an OIG Exclusion
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.

Quick Guide to Exclusion Searches : LEIE
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.

State Medicaid Fraud Control Units Must Inform OIG Within 30 Days
State Medicaid Fraud Control Units Must Inform OIG Within 30 Days

State Medicaid Fraud Control Units (MFCU) are responsible for investigating Medicaid fraud. This is part of the responsibility assigned to them from CMS as a part of receiving federal health care dollars to reimburse those services and items covered by Medicaid.According to the OIG site, "Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud as well as patient abuse or neglect in healthcare facilities and board and care facilities. MFCUs operate in 49 states and the District of Columbia. The MFCUs, usually a part of the State Attorney General's office, employ teams of investigators, attorneys, and auditors; are constituted as single, identifiable entities; and must be separate and distinct from the State Medicaid agency. OIG, in exercising oversight for the MFCUs, annually re-certifies each MFCU, assesses each MFCU's performance and compliance with Federal requirements, and administers a Federal grant award to fund a portion of each MFCU's operational costs."Performance Standard 8(f) states that a Unit should transmit to the federal OIG reports of all convictions for the purpose of exclusion from Federal health care programs, within 30 days of sentencing. On June 1, 2012, the Federal Register published an important mandate to measure the success of state Medicaid Fraud Control Units. 

If you haven’t heard yet! On Demand Exclusion Data Workshop Available
If you haven’t heard yet! On Demand Exclusion Data Workshop Available

Exclusion Workshop If you haven't heard yet about our monthly webinars. No worries! For all who attended last month's Exclusion Data Deep Dive Workshop, it was a pleasure meeting each one of you. If you didn't get a chance to join us, you were certainly missed! We also want to take a special moment and share the actual webinar with you. And the best part is - it's free! And there were some interesting exclusion finds from this quarter's special report, CHIRP, too. We have a special on demand version of our October workshop available for you today.

Exclusion Data Deep Dive Workshop
Exclusion Data Deep Dive Workshop

Today is the day! Join us at 12:00 PM CST for our webinar titled, "Exclusion Data Deep Dive Workshop" In this workshop, we will discuss the time delay in states reporting  to the OIG and the missing exclusions on the OIG list.  You may know that states are not good at reporting exclusions to the OIG, but you may not know just how bad they are at reporting.  Join the compliance conversation today! Reserve your seat now.

Yes Virginia, There is an MFCU Delay in Reporting to the OIG
Yes Virginia, There is an MFCU Delay in Reporting to the OIG

MCFU Not Reporting The Virginia Medicaid Fraud Control Unit (MFCU) recovered $34 for each $1 spent on fighting healthcare fraud. However, with those stellar results, the MFCU did not report half of all convictions to OIG within required timeframes. The Unit did not report 42 of its 79 convictions to OIG within 30 days of sentencing, as required by Federal regulations.

Sitting Pretty with Healthcare Compliance Data
Sitting Pretty with Healthcare Compliance Data

Data in Healthcare Data has been a buzzword around for the last couple of years now in just about every industry. Healthcare is no exception. We all know we need it, we know that it’s important and we should be tracking it. However, when it comes to healthcare the word “data” still feels a little ambiguous sometimes. Do you think it is the case because there is so much information to be aware and track when it comes to effective healthcare compliance?

The compliance risks of a low-cost exclusion monitoring vendor
The compliance risks of a low-cost exclusion monitoring vendor

The same practicality of investing in premium brands can be seen across all industries.   How many of you have searched a website that aggregates hotel sites to find the "same room" at a lower cost? I admit I have. But did I actually get what I thought I was bargaining for?  Nope – not even close. In fact, the room available was advertised on the web as the same as the hotel site, but for much more. Upon arrival, the “available room" was no longer available. What was available was a room with a view of the loading dock and dumpster in the back corner of the lowest floor. Sometimes lower cost is an indicator of something bigger – or lesser, depending on how you look at it. 

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