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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, Compliance Plan, compliance officer

A Corporate Integrity Agreement is Coming, What Should I Do Now?

Posted by Donna Thiel on Thu, Apr 06, 2017

Plan

The first thing you should do is realize that the clock is already ticking and you need to start preparing. There are many phases to implementing a Corporate Integrity Agreement (CIA) but Phase I actually starts before the CIA is even signed.

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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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Healthcare Compliance, Compliance Plan, compliance, healthcare audit, compliance program

Getting C-Suite to Buy Into Your Compliance Budget

Posted by Michael Rosen, ESQ on Thu, Jan 19, 2017

Getting Noticed:
Compliance is a tough job. It is thankless and often seen as the watchful eye. However, if ever there was a time to highlight the importance of compliance in healthcare, 2017 is the time.  Why? Well, just look at it from the perspective of the OIG or Department of Justice (DOJ).  

The OIG reported that in 2016, fraud and abuse was the number one problem facing healthcare when it comes to fines and punishment. Cases stemming from False Claims Act,  poor quality of care, fraudulent billing, and Stark violations dominated the news.  In the latest report on Fraud and Abuse in 2016, the combined efforts of the HHS OIG and DOJ won or negotiated over $2.5 billion in health care fraud judgments and settlements 2 , and it attained additional administrative impositions in health care fraud cases and proceedings. As a result of these efforts, as well as those of preceding years, in FY 2016 over $3.3 billion was returned to the Federal Government or paid to private persons.

 In FY 2016, investigations conducted by HHS’ Office of Inspector General (HHS-OIG) resulted in 765 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 690 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties (CMP) settlements, and administrative recoveries related to provider self-disclosure matters. HHS-OIG also excluded 3,635 individuals and entities from participation in Medicare, Medicaid, and other federal health care programs. Among these were exclusions based on criminal convictions for crimes related to Medicare and Medicaid (1,362) or to other health care programs (262), for patient abuse or neglect (299), and as a result of licensure revocations (1,448). HHS-OIG also issued numerous audits and evaluations with recommendations that, when implemented, would correct program vulnerabilities and save program funds.

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OIG Exclusion List, Healthcare Compliance, OIG, CMS, Compliance Plan, internal audit, OIG Exclusion, Compliance Audit, compliance auditor

Seven Mistakes to Avoid when Performing a Compliance Audit

Posted by Michael Rosen, ESQ on Tue, Dec 06, 2016

For our last blog in our audit series, we are sharing insights on effective internal compliance auditing.


New to the scene? Check out our audit series:
Hi, I am an Auditor and I am Here to Help
How to Conduct an Effective Health Care Audit
Be Audit Ready - All the Time
You've Finished Your Internal Audit. Now What?


Let’s face it - healthcare auditors have a tough job today. In order to be effective and relevant it requires careful analysis and investigative skills, while at the same time garnering support and respect from departments and people who may see you as the “Corporate Cop.” The pressure is high. There is a lot of importance placed on auditors to ask the right questions and dig in the right places to have a solid, accurate review.

On top of this, senior management and Board of Directors rely heavily upon a compliance auditor’s results to determine where there are weaknesses, areas for improvements, and/or violations of regulations that may require self-disclosure.

Here are seven mistakes others made to gain insight on what Federal regulators (HHS OIG) deem important or  compliance audit.

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Healthcare Compliance, Compliance Plan, audit

Hi, I am an Auditor and I am Here to Help

Posted by Michael Rosen, ESQ on Thu, Nov 10, 2016

The only thing possibly scarier than those words is – "I am from the IRS and I am here to help."  Well, it doesn't have to be that way. Auditors get a bad wrap. The first image that comes to mind is the corporate cop without a personality who is just looking for that violation. But an audit is a very important part of an effective compliance program. In fact, it is one of the seven elements.

The purpose of a healthcare compliance audit is four fold:
1. To prove you are in compliance
2. To show areas where they can be improved 
3. To cement into place best practices that you have implemented and to make your organization's compliance plan even better, and 
4. To be ready to pass an outside party/regulator official audit.

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