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The ProviderTrust Blog

Your source for healthcare compliance news, advice from industry experts, and all things related to OIG exclusions.

Healthcare Compliance, Fraud and Abuse

Healthcare Business Owner is Just as Liable for Fraud

Posted by Michael Rosen, ESQ on Thu, Feb 23, 2017

A California man who operated rehabilitation clinics in Walnut, Torrance and Los Angeles and defrauded Medicare out of approximately $3 million by billing for unneeded or unnecessary services has been sentenced to 121 months in federal prison. 

Among other defendants, Simon Hong owned physical therapy clinics operated by companies called Hong’s Medical Management, Inc., CMH Practice Solution, and HK Practice and Solution, Inc.  As part of the scheme, Hong recruited Medicare beneficiaries and provided uncovered services like massage and acupuncture for them. Even though the beneficiaries did not receive actual physical therapy, Hong’s co-conspirators billed Medicare for physical therapy, and then funneled 56 percent of the reimbursement funds back to Hong.

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OIG, mfcu

State Medicaid Fraud Control Units: You have 30 Days

Posted by Michael Rosen, ESQ on Tue, Feb 21, 2017

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 healthcare dollars to reimburse those services and items covered under 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."

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Healthcare Compliance, Compliance Plan, compliance, compliance officer

Compliance Managers Rejoice!

Posted by Michael Rosen, ESQ on Thu, Feb 16, 2017

Glassdoor names ‘Compliance Manager’ as 25th best job in 2017!

On January 23, 2017, Today reported, Glassdoor compiled its annual jobs report to hunt down the 50 Best Jobs in America for 2017, based on how well they meet the criteria for overall job score. And guess what? Complaince is King (or Queen)!

This job catapults in the list to #25.

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OIG, Fraud and Abuse, exclusions, OIG Exclusion, exclusions list

Seven Things You Might Not Know About OIG Exclusions

Posted by Michael Rosen, ESQ on Tue, Feb 14, 2017

If you work in health care, you are certainly no stranger to the terms “OIG “ and “exclusion.” In fact, you have likely had a nightmare or two on the subject, especially if you work in compliance. While the terms are a hot topic in the health care industry, there is still a lot of mystery surrounding the OIG exclusion process and what is "OIG exclusion list."

Keep reading to discover 7 not-so-obvious things you should know about OIG exclusions:

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Fraud and Abuse, Penalties and Fines, Enforcement

Executive Liability is Here to Stay - Ask These Three CEO's

Posted by Michael Rosen, ESQ on Thu, Feb 09, 2017

Sally Yates & The Yates Memo

Deputy Attorney General Sally Yates was serious when she said in her Yates Memo that her office will go deep into the organization and hold those persons who are found to have committed fraud personally liable. These are no longer scary words on paper or idle threats. If you need proof or don't believe her, ask these three senior healthcare executives their experience...

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