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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, Affordable Care Act, Medicaid

State Medicaid Agencies Still Challenged with Determining When to Implement Payment Suspensions

Posted by Michael Rosen, ESQ on Thu, Sep 14, 2017

 The Office of Inspector General (OIG) for Health and Human Services (HHS) was given several new powers under the Affordable Care Act (ACA) that added to their hammer of enforcement. According to the HHS OIG, State Medicaid agencies are required to suspend payments for healthcare items and services when there is a “credible allegation of fraud” against the provider, unless “good cause” exists not to suspend payment.  

Using payment suspensions, when appropriate, is important to protect Medicaid funds: payment suspensions based on credible allegations of fraud can swiftly stop the flow of Medicaid dollars to providers defrauding Medicaid. A payment suspension can remain in place throughout a law enforcement investigation and potential prosecution of a healthcare fraud case.

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Industry News, CMS, Medicaid, Medicare

CMS Helps Ease Restrictions During Hurricane Harvey Recovery

Posted by Michael Rosen, ESQ on Thu, Sep 07, 2017

There’s no doubt it will take quite some time to fully understand the scope of damage done in the aftermath of Hurricane Harvey. So many individuals have felt the force of this disaster, and sometimes the most vulnerable victims are the ones who rely on healthcare for their most basic everyday needs.

Last week, the Centers for Medicare & Medicaid Services responded to this dilemma in a statement that explains some of the actions being taken to address serious concerns during the recovery process.

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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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