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.Read More
Former Chief Executive of South Carolina Hospital Pays $1 Million and Agrees to OIG Exclusion to Settle Claims Related to Illegal Payments to Referring PhysiciansRead More
A federal judge sentenced the CEO of an Illinois Home Health company to six (6) years in prison following a jury verdict convicting on grounds of fraudulently billing Medicare for millions of dollars of unnecessary services. The Assistant U.S. Attorney that prosecuted the case commented that "Home-health fraud has become a significant problem nationally and particularly in the Chicago area."Read More
A National Provider Identification number (NPI) is unique to healthcare. An NPI in healthcare is an identification number issued by the National Provider System (NPS) based on information entered into the NPS by one or more organizations known as "enumerators." The NPI number is unique to each person or entity applying for such number. It is created to improve the efficiency and effectiveness of electronic transmission of health information.
Covered entities under HIPPA must use NPI's to identity health care providers in HIPPA standard transactions. The NPI number is required to submit claims or conduct other transactions specified by HIPPA. By definition, a health care provider" is an individual, group or organization that provides medical or other health service or supplies." This would include physicians an other practitioners, physician/practitioner groups, institutions such as hospitals, laboratories and nursing homes, health maintenance organizations and suppliers such as pharmacies and DME companies. However, it does not include health industry workers such as admissions and billing personnel, housekeeping staff, orderlies and those who support the provision of health care, but do not provide health care services.Read More
The OIG reviewed the performance of the Florida state Medicaid Fraud Control Unit ("Unit") (2015 Onsite Review) and released its findings in June 2016. The OIG found that the Unit did not report all convictions and adverse actions to the Federal government as required by Performance Standard 8(f) within required timeframes.
Performance Standard 8(f) states that a Unit should transmit to the federal OIG "reports of all convictions for the purpose of exclusion from Federal health care programs, within 30 days of sentencing." The Unit reported their staff erred in failing to follow guidelines and to report convictions and adverse actions within the required time frames.
Further, the OIG found that of the 193 convictions obtained by the Unit half did not report within required time frame (30 days of sentencing) and 10 did report prior to the onsite review.
Of the convictions they did report:Read More