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The ProviderTrust Blog

Your source for healthcare compliance news, advice from industry experts, and all things related to OIG exclusions.

Industry News, OIG, Penalties and Fines, OIG Exclusion

Student Loan Crisis: Exclusions Issued for Defaulting on Loans

Posted by Michael Rosen, ESQ on Tue, Jun 13, 2017

As a nation we're facing a serious student loan crisis. Whether you paid off your loans years ago, continue to pay them off now, or helping your children or grandchildren with their share of loans, we've all encountered the massive amounts of student debt piling up. 

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Fraud and Abuse, Penalties and Fines, compliance, false claims act

Three Times is Not a Charm: Court Triples Whistleblower Damages

Posted by Michael Rosen, ESQ on Tue, Mar 21, 2017

Here is a fast moving case to watch and one that has a not so happy outcome. On March 1, 2017, a Florida federal judge awarded the U.S. and Florida governments more than $347M in trebled (three times) damages following a jury trial in a False Claims Act case. This case has many aspects that make it unique and costly, but one interesting fact is that it was a rare case in which the case went to trial and received a jury verdict of $115M in a False Claims Act case. 

The case highlights a major concern for the OIG, as outlined in the 2017 OIG Work Plan. The OIG Work Plan specifically addresses nursing home/facility fraud concerns, stating that, "Previous OIG work found that (skilled nursing facilities) are billing for higher levels of therapy that were provided or were reasonable or necessary." So the OIG proposed to and, in this case, reviewed documentation at selected skilled nursing facilities to determine it met the requirements for each particular resource utilization group. The involved sophisticated data mining and analytics, now deployed at the OIG.
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Fraud and Abuse, Penalties and Fines, Enforcement

Executive Liability is Here to Stay - Ask These Three CEO's

Posted by Michael Rosen, ESQ on Thu, Feb 09, 2017

Sally Yates & The Yates Memo

Deputy Attorney General Sally Yates was serious when she said in her Yates Memo that her office will go deep into the organization and hold those persons who are found to have committed fraud personally liable. These are no longer scary words on paper or idle threats. If you need proof or don't believe her, ask these three senior healthcare executives their experience...

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Fraud and Abuse, Penalties and Fines, exclusions

50 is the New 20: First 50-Year Exclusion Imposed

Posted by Michael Rosen, ESQ on Thu, Jan 26, 2017

What happens if you are unlicensed, excluded, own a dental practice, bill CMS for federally reimbursed heatlhcare services and submit false claims?  To compare to the game Monopoly, you quickly go past jail and pay $1.1M as well as agree to one of the longest exclusions ever with the OIG.   

OIG alleged that from November 2005 through October 2012, Brookhim owned, controlled, and managed Associated Dental NP, LLC (ADNP), a New Jersey dental practice with multiple locations, in violation of his exclusion from Federal health care program participation in August 2000.

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OIG Exclusion List, OIG, Fraud and Abuse, Penalties and Fines, OIG Exclusion

NOTICE: New OIG Exclusion Authority for Fines and Penalties

Posted by Michael Rosen, ESQ on Tue, Jan 24, 2017

Hey, we don't want to exclude you from the news, so here is the skinny. The OIG has new and expanded exclusion authorities, and as we will outline below, the fines have increased, in some cases double since last year. The Final Rule effective date is February 13, 2017.

On December 6, 2016, the U.S. Dept. of Health and Human Services, Office of Inspector General (OIG) issued rules that incorporate new civil and monetary fines and penalties (CMP) authorities, clarify existing authorities, and reorganize regulations regarding CMP’s. The Final Rule also implements provisions of the Affordable Care Act (ACA) of 2010 that authorizes CMP’s for:
  1. Failure to grant the OIG timely access to records
  2. Ordering or prescribing while excluded
  3. Making false statements, omissions, or misrepresentations in an enrollment application
  4. Failure to report and return over payments, and
  5. Making or using a false record or statement that is material to a false of fraudulent claim
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