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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, Medicaid, Medicare, Fraud and Abuse, department of justice

The OIG is Serious About Personal Care Fraud: Cruisin’ for a Bruisin’

Posted by Michael Rosen, ESQ on Thu, Apr 20, 2017

The OIG has heard and seen it all, right? It is hard to imagine the daily insanity of discovering and investigating fraudulent behavior within the healthcare industry. One thing is for sure; they are not messing around.

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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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Healthcare Compliance, Fraud and Abuse

Healthcare Business Owner is Just as Liable for Fraud

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

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OIG, Fraud and Abuse, exclusions, OIG Exclusion, exclusions list

Seven Things You Might Not Know About OIG Exclusions

Posted by Michael Rosen, ESQ on Tue, Feb 14, 2017

If you work in health care, you are certainly no stranger to the terms “OIG “ and “exclusion.” In fact, you have likely had a nightmare or two on the subject, especially if you work in compliance. While the terms are a hot topic in the health care industry, there is still a lot of mystery surrounding the OIG exclusion process and what is "OIG exclusion list."

Keep reading to discover 7 not-so-obvious things you should know about OIG exclusions:

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