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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, 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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Healthcare Compliance, OIG, Long Term Care, compliance program

Healthcare Compliance Updates - New ROP Changes

Posted by Donna Thiel on Thu, Jan 12, 2017

As we all know the new Requirements of Participation (ROP) for Skilled Nursing Facilities (SNF) were published in the Federal Register on October 4, 2016 with the Phase 1 requirements going into effect on November 28, 2016.  The Requirements of Participation have not been significantly altered in nearly 25 years.  So as you can imagine, there are some significant changes that come with these new Requirements.

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OIG Exclusion List, OIG, exclusions, compliance, OIG Exclusion, compliance program

The Best of 2016: Resources Just in Time for the New Year!

Posted by Michael Rosen, ESQ on Thu, Dec 29, 2016

ProviderTrust 2016 Resources

It's been a wonderful, busy year! There were many changes that took place in healthcare and more specifically, compliance. As we faced those challenges, we partnered with many of you to walk through those changes and ultimately, learn how to serve your compliance programs even better. 

We understand that new regulations effect how you perform you're job and the quality to which you do that work. It is very difficult to study, learn, and implement the changes in a timely manner, especially when it takes additional work on top of what you already do in order to keep up. 

Who has time for that? Well, we do! In this blog, we've got our best resources from 2016 - all in one place!

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