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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, OIG, healthcare, HCCAci

HCCA 21st Annual Compliance Institute Debrief

Posted by Michael Rosen, ESQ on Thu, Mar 30, 2017

There is nothing like D.C. in the spring. The Healthcare Compliance Association (HCCA) held its annual Compliance Institute in DC for 2017 and almost 3,000 of the nation’s compliance officers/managers gathered at the Gaylord National Harbor for three days. As has been the case for years, the conference was spectacular.

It is refreshing to be around so many people who share the same goal - compliance and quality care.

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ProviderTrust News, compliance, HCCA, HCCAci

Everything You Need to Know for HCCA CI 2017

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

HCCA Compliance Institute begins this weekend, and year after year, it never disappoints! At ProviderTrust,
meeting new faces and reuniting with friends has always been our favorite part of this enjoyable event.

As we prep for our journey to the National Harbor in Maryland, we made it a priority to put together some resources for you - in the event you get to go - so that you get the most out of your HCCA CI 2017 experience!

Take a look below to start planning, and be sure to say hello if you see us.

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Fraud and Abuse, Penalties and Fines, compliance, false claims act

Three Times is Not a Charm: Court Triples Whistleblower Damages

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

Here is a fast moving case to watch and one that has a not so happy outcome. On March 1, 2017, a Florida federal judge awarded the U.S. and Florida governments more than $347M in trebled (three times) damages following a jury trial in a False Claims Act case. This case has many aspects that make it unique and costly, but one interesting fact is that it was a rare case in which the case went to trial and received a jury verdict of $115M in a False Claims Act case. 

The case highlights a major concern for the OIG, as outlined in the 2017 OIG Work Plan. The OIG Work Plan specifically addresses nursing home/facility fraud concerns, stating that, "Previous OIG work found that (skilled nursing facilities) are billing for higher levels of therapy that were provided or were reasonable or necessary." So the OIG proposed to and, in this case, reviewed documentation at selected skilled nursing facilities to determine it met the requirements for each particular resource utilization group. The involved sophisticated data mining and analytics, now deployed at the OIG.
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Fraud and Abuse, compliance, Compliance Audit

We Told You It was Going to Get Personal

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

Healthcare liability is getting personal. Following the Sally Yates Memo, the DOJ has set certain guidelines and let it be known that they will pursue the individuals personally for their role in committing fraud.

In this blog we discuss a few cases that show that although Sally Yates may not personally be there to lead the charge, but the bull is definitely out of the cage. 

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Long Term Care, compliance, SNF, SNF Requirements

Part 3: SNF Requirements of Participation - Licensing

Posted by Donna Thiel on Tue, Mar 14, 2017

New Requirement in § 483.12 Freedom from abuse, neglect, and exploitation.

Did you read the new Skilled Nursing Facility Requirements of Participation (ROP) section 483.12 carefully? In a document of nearly 200 pages and three columns of small print, sometimes it is easy to miss an important change. I read the new ROP multiple times and until just a few weeks ago I missed an important new requirement in the Freedom from abuse, neglect and exploitation section. Hopefully, you aren’t like me and you saw this already but just in case I thought I would highlight the change for you and give you some great news about meeting this new requirement.

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