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The ProviderTrust Blog

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

Industry News, Medicaid, Data Management

New Mexico Takes Aim at Medicaid Fraud and Abuse

Posted by Donna Thiel on Tue, Aug 01, 2017

New Mexico’s Attorney General Hector Balderas takes Medicaid fraud very seriously, and late last week announced several new initiatives to weed out Medicaid fraud in his state. For the first time in New Mexico’s history, the Attorney General has requested and received a waiver from the federal government to allow the Office of the Attorney General to proactively search through data to identify patterns of fraud.

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OIG Exclusion List, OIG, Medicaid, mfcu

MFCU Reporting Accuracy: Then and Now

Posted by Michael Rosen, ESQ on Thu, Jul 13, 2017

The Office of Inspector General (OIG) is not the only source for exclusions. Did you know that the state Medicaid agency and/or State Attorney General, if applicable, in each state must report its actions to the Federal OIG promptly after the agency takes a final action? (Social Security Act 1902(a)(41) and 42 CFR 1002.3(b)(3). In this article, we'll take a look at how well reporting has taken place given the latest OIG research data, and compare Q1 2017 results from our latest CHIRP report.

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Industry News, OIG, Medicaid, Fraud and Abuse

C-Suite and General Counsel Held Liable for Medicaid Fraud

Posted by Michael Rosen, ESQ on Tue, Jul 11, 2017

Larger healthcare companies typically employ an entire and robust legal department in-house to handle legal work and provide good counsel to management and senior executives. Some of these companies will hire outside counsel to supplement areas of expertise that may be lacking by an internal department. But what happens when that advice or legal counsel is considered to be fraudulent? Who is liable? Who takes the fall and can be subject to the long arm of the law?

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OIG, Medicaid, exclusion monitoring

States with the Most Excluded Parties

Posted by Michael Rosen, ESQ on Thu, Jul 06, 2017

Which states have the most exclusions? Glad you asked! First off, did you know that there are 40 states that have a state Medicaid exclusion list in addition to the two federal exclusion datasources (OIG-LEIE and SAM.gov)? Did you also know that a state Attorney General’s Office and/or Medicaid Agency can impose an exclusion on a person or entity in addition to the OIG? In today’s compliance environment, it’s important to have a comprehensive monitoring program that is placing just as much emphasis at the state level to achieve 100% compliance.

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OIG, Medicaid, Fraud and Abuse

Mother and Son Conspire to Defraud Medicaid

Posted by Michael Rosen, ESQ on Thu, May 25, 2017

Does it matter whose license is used to bill CMS for services? Don’t ask these moms - they don’t know best!

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