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.Read More
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.
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...
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.Read More
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:
- Failure to grant the OIG timely access to records
- Ordering or prescribing while excluded
- Making false statements, omissions, or misrepresentations in an enrollment application
- Failure to report and return over payments, and
- Making or using a false record or statement that is material to a false of fraudulent claim
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