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

Delays in Reporting OIG Exclusions: Florida can't Blame the Hurricane

Posted by Michael Rosen, ESQ on Thu, Jun 16, 2016

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:

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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

This blog elaborates on the time delays in the reporting of disciplinary actions to state licensing boards and how those delays impact monthly monitoring of licenses for healthcare organizations.

The differences in reporting between the states:

Just like the reporting delay between the state Medicaid exclusion lists and the OIG, there can be delays in reporting disciplinary actions to the individual licensing boards. This happens for many reasons. The main reason for this delay is due to the inconsistency in how and when the states release and publish the minutes of the disciplinary actions by the board.

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