It pays to play nice and when others don’t, CMS can put a big bite in the potential for new Medicare and Medicaid providers. If this is news to you, it is to most people.
You might hesitate to self-disclose fraud and exclusions to the OIG due to the time-investment and immediate fines; however, according to the OIG the process does not take as long as you might think.
Recently, the Joint Commission released a chart of the most challenging requirements for health care organizations. Interestingly, for Behavioral health care companies, HR 01.02.05 Standard proved to be one of the more challenging compliance standards to meet. See chart.
Using funds allocated as part of healthcare reform (Affodable Care Act), CMS (Center for Medicare & Medicaid Services) has stepped up efforts to locate and stop medicare fraud nationwide. As quoted from a recent Business Wire article, Donovan Ayres, Vice President of Regulatory Compliance at Clear Vision Information Systems, "CMS is being more aggressive than ever in making sure that all Medicare Advantage plans are in full compliance."
The OIG recently recently its 2012 review of the Louisiana State Medicaid Fraud Control Unit. Among other findings, the review found that 14% of sentenced providers were not referred to the OIG for exclusion within the appropriate time period ("30 days or other reasonable time period" according to Performance Standard 8(d)). These providers were not reported to the OIG until after the review.
Topics: oig exclusion list, civil fines and penalties, oig exclusion check, monthly oig exclusion monitoring, OIG, exclusions, Affordable Care Act, OIG Exclusion Monitoring, Medicaid, Medicare, Fraud and abuse, OIG exclusion list check, Fraud Control, Lousiana Fraud Control, OIG Review