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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, 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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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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OIG Exclusion List, Industry News, OIG, Medicaid, Medicare, Fraud and Abuse, Penalties and Fines

Healthcare Fraud: From CEO to CE NO

Posted by Michael Rosen, ESQ on Tue, Oct 11, 2016

Former Chief Executive of South Carolina Hospital Pays $1 Million and Agrees to OIG Exclusion to Settle Claims Related to Illegal Payments to Referring Physicians

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OIG, Medicaid, Fraud and Abuse

When Home Health is Unnecessary Care- and Fraud

Posted by Mike Rosen on Tue, Aug 02, 2016

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."  

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OIG Exclusion List, Healthcare Compliance, OIG, Medicaid, Healthcare Technology, Medicare, Data Management

Three Things to Know about NPI in Healthcare

Posted by Michael Rosen, ESQ on Tue, Jun 28, 2016

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.  

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