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The ProviderTrust Blog

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

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, OIG Work Plan, compliance program

August OIG Work Plan Updates

Posted by Michael Rosen, ESQ on Thu, Aug 24, 2017

Each month, we will be sharing 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.

Read More

OIG, OIG Work Plan, compliance program

July OIG Work Plan Updates

Posted by Michael Rosen, ESQ on Thu, Jul 27, 2017

As of June 2017, the Office of Inspector General (OIG) began providing updates to their Work Plan on a monthly basis. This will help compliance professionals update their plan or make sure they are continuing to focus on the most current OIG priority areas. The online updates will allow direct access to providers and other visitors.

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OIG, Fraud and Abuse, corporate integrity agreements, compliance program

Corporate Integrity Agreements are Not a Right

Posted by Michael Rosen, ESQ on Tue, Apr 25, 2017

There are many misunderstandings in the compliance world on how CIAs are used and whether or not the OIG is obligated to enter into one. The OIG does not have to enter into a Corporate Integrity Agreement, nor does a provider have an automatic right to one.

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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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