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The ProviderTrust Blog

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

Industry News, Healthcare Compliance, SNF

September Healthcare Compliance News

Posted by Michael Rosen, ESQ on Tue, Sep 26, 2017

September 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 articles on data security and the common problem of shrinking compliance budgets and how to make the most of them. Take a look! 

 

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OIG, OIG Work Plan, compliance program

September OIG Work Plan Updates

Posted by Michael Rosen, ESQ on Tue, Sep 19, 2017

Each month, we are pleased to share the most recent additions to the Office of Inspector General (OIG) Work Plan items. As of June 2017, OIG updates their Work Plan monthly with any new changes to the active list. Let’s take a look at the new points of emphasis for compliance professionals moving forward.

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OIG, Affordable Care Act, Medicaid

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

Posted by Michael Rosen, ESQ on Thu, Sep 14, 2017

 The Office of Inspector General (OIG) for Health and Human Services (HHS) was given several new powers under the Affordable Care Act (ACA) that added to their hammer of enforcement. According to the HHS OIG, State Medicaid agencies are required to suspend payments for healthcare items and services when there is a “credible allegation of fraud” against the provider, unless “good cause” exists not to suspend payment.  

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.

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Industry News, CMS, Medicaid, Medicare

CMS Helps Ease Restrictions During Hurricane Harvey Recovery

Posted by Michael Rosen, ESQ on Thu, Sep 07, 2017

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.

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Healthcare Compliance, Healthcare Technology, audit, healthcare audit, auditor

How to Conduct an Effective Healthcare Compliance Audit

Posted by Donna Thiel on Tue, Sep 05, 2017

Compliance auditing, what a process. There are always so many potential areas to be audited, and often it is difficult to decide where to start. How many different risk areas did you identify when you were working on your compliance plan? Can you possibly audit all of these areas? Did you rate or rank the risks to identify where you have the biggest concerns?

Do you have the resources; time and or people? Do you have the expertise? Do you have an internal audit team or are you using contract auditors? 

How often should you audit? What do you do with the audit findings? I am tired already, and we haven’t even gotten started.  

*Updated from original post on 11/15/2016

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