Tag: OIG

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Case Studies

How University Health Prevented Impending Fraud in One Day

Death Master File Exclusions OIG
Blog

How to Conduct an Effective Healthcare Compliance Audit

OIG
Blog

2024 HHS-OIG Top Areas of Focus

OIG Payers Providers

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Blog

Webinar Recap: How Comprehensive Vendor Monitoring Mitigates Risk

OIG Providers Vendor Compliance
Blog

Highlights from the HHS-OIG 2023 Spring Semiannual Report

Exclusions Industry News OIG
Whitepapers

Compliance Gaps in Due Diligence: Lessons Learned from a $25 million FCA Settlement

Industry News OIG Providers
Webinars

Ahead of the Curve: How Comprehensive Vendor Monitoring Mitigates Risk

OIG Providers Vendor Compliance
Blog

Medicaid Fraud Control Unit’s 2022 Annual Report Key Takeaways

Industry News Medicare and Medicaid OIG
Blog

How to Prevent Medicare Advantage Fraud, Waste, and Abuse

Medicare and Medicaid OIG Payers
Blog

Operation Nightingale and Protecting Your Organization from Potential Licensure Fraud

Industry News OIG Providers
Blog

An Overview of the New York OMIG Exclusion List

Exclusions Medicare and Medicaid OIG
Whitepapers

Data Enrichment Guide

Exclusions OIG Providers

Compliance Risk Assessment: Preparation and Use of Action Plans


Check out the full compliance risk assessment series here:

1. Integrating basics into your compliance plan
2. Integrating tools into your compliance plan
3. How reliable data improves your compliance plan
4. Preparation and use of action plans


This is a follow up to the three-part series of the “Risk Assessments” blogs. As a reminder, the blogs addressed considerations in conducting risk assessments for healthcare providers and organizations, different types of tools and methods that can be used in these assessments, and what to do with the information obtained from the assessments, including reporting results of the assessments and mitigating identified risks.

The next step in the compliance risk assessment process is developing and implementing action plans needed from the results of the assessments.

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Medicaid Termination in One State – now what?

Prior to the passage of the Affordable Care Act, a provider terminated from Medicaid enrollment, or eligibility, in one state could easily slip through the cracks and enroll in another state. Most states did not share or have access to a centralized database of terminated Medicaid providers. Obviously, this is not good for ferreting out fraud and preventing a terminated provider (especially if he/she was terminated for fraud and/or abuse) from hopping state lines and enrolling in another state.  

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Can Excluded Physicians Refer, Order or Prescribe?

Seems like a simple question. But the answer may surprise you. There are three things that are needed for a referral to be legitimate and to avoid potential civil fines, penalties and OIG exclusions. 

1.  Does the Physician have a current license without restrictions?

2.  Is the Physician privileged or credentialed at the hospital?

3.  Is the Physician excluded from participating in Medicare/Medicaid or other federal health care dollar reimbursed programs?

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Does Employer need Employee Permission to Monitor for OIG Exclusions?

Employers have an initial Release and Authorization to conduct a pre-employment background check upon hire.  A proper Release will contain additional language that allows the employer to conduct additional searches “during the scope of the employee’s tenure” with the company.  The employer is allowed to conduct additional searches without obtaining a new release in the event of a substantiated inquiry into fraud or other illegal activity.

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