Prior to the passage of the Affordable Care Act, a provider terminated from Medicaid enrollment, or eligibility, in one state could easily slip through the cracks and enroll in another state. Most states did not share or have access to a centralized database of terminated Medicaid providers. Obviously, this is not good for ferreting out fraud and preventing a terminated provider (especially if he/she was terminated for fraud and/or abuse) from hopping state lines and enrolling in another state.Read More
Newly appointed Loretta Lynch came out of the box swinging. The HHS OIG and the US Attorney General announced a nationwide "sweep" led by the Medicare Fraud Strike Force in 17 districts. The charges were filed against 243 individuals, which included 48 doctors, nurses and other licensed medical professionals. The crackdown of health care fraud and abuse represents the largest coordinated take-down in healthcare history, both in terms of the number of defendants charged and loss amount.Read More
The OIG released its Annual Report on Medicaid Fraud Control Units for 2014. This report highlights statistical achievements from the investigations and prosecutions conducted by 50 MCFU's in the U.S. The report found that enforcement, civil and criminal, were up, but there were gaps in reporting some records to the OIG.Read More
Are you a healthcare organization at the larger end of the scale and have already acquired another healthcare facility or vendor?
If you said yes to that question there are a few things to keep in mind:Read More