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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 Exclusion List, Healthcare Compliance, OIG, Medicaid, Medicare, Fraud and Abuse, Penalties and Fines, Sanction Screening, Long Term Care, License Verification

Healthcare license fraud is a reality - here's how to avoid it

Posted by Michael Rosen, ESQ on Thu, May 26, 2016

How can a company protect itself from a fraudulent employee?

For those of us who work in the healthcare industry, we all know how imperative and complicated healthcare licenses can be. Ensuring employee’s licenses are up to date and properly verified can be a headache for organizations industry-wide. Although organizations might think they are doing everything correctly and thoroughly, they could be terribly wrong. Errors in the healthcare license verification and tracking process is a very real possibility, especially in large companies that have thousands of employees and vendors. And yes, it is the company’s responsibility to verify all licenses and all other required documents.

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OIG Exclusion List, Healthcare Compliance, OIG, Medicaid, Medicare, Fraud and Abuse, Penalties and Fines, Sanction Screening, Long Term Care

Time Delays in Healthcare License Reporting to State Licensing Boards 

Posted by Michael Rosen, ESQ on Thu, May 19, 2016

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

48-year OIG exclusion deemed fair for $200 million in fraud

Posted by Michael Rosen, ESQ on Tue, May 10, 2016

 
Forty-eight years is practically half a century. It is also the amount of time an excluded physician received and was upheld by the Administrative Law Judge (ALJ) in  a recent appeal in Louisiana. This case tested the tenets of the exclusion authority and factors that can be taken into account when issuing an exclusion term.  

In Zahid Imran, M.D. v. OIG (2016 BL 111001, HHS Departmental Appeals Bd., Appellate Div., Dec. No. 2680, 3/11/16), the board sustained the exclusion of a physician from all federal healthcare programs for 48 years due to the physician's conviction for felony healthcare fraud and the existence of several aggravating factors. Zahid Imran, a physician formerly licensed in Louisiana, pled guilty to one felony count of Medicare fraud based on a six-year long scheme in which he and others admitted patients who either didn't qualify for partial hospitalization or for whom partial hospitalization wasn't medically necessary. As part of the plea agreement, Imran stipulated the calculated loss to Medicare was between $50 million and $200 million. 

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Industry News, Healthcare Compliance, OIG, CMS, Medicaid, Medicare, Fraud and Abuse

The Bundled Payment Initiative and the Healthcare Compliance Industry

Posted by Joey Convertino on Tue, May 03, 2016

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

If there was ever a Case for an OIG Exclusion- this is it.

Posted by Michael Rosen, ESQ on Tue, Mar 01, 2016

An owner of an imaging/diagnostics firm was convicted of fraud, identity theft, false billing and will face life in prison for the deaths of two patients. The CEO and co-owner of a Maryland diagnostics company is facing that sentence after a jury convicted him of two counts of healthcare fraud that resulted in death. The Department of Justice announced last week the results of the court case. 

Results - 

Mr. Rafael Chikvashvili of Baltimore, Maryland was convicted of defrauding Medicare and Medicaid of more than $7.5 million. To make matters worse, “The evidence showed that Rafael Chikvashvili failed to provide medical services to patients who needed them, and billed for services that he did not provide,” said U.S. Attorney Rod J. Rosenstein. “The jury found two patients died because their X-rays were not reviewed by a qualified radiologist. Health care fraud has consequences, in money wasted and lives lost.”

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