HHS Moves to Reduce 700,000 Cases and Eleven Year Backlog
HHS has proposed key changes in the Medicare appeals process to help reduce the backlog of more than 700,000 cases.…
Common Characteristics of Home Health Fraud Cases
OIG Reports Home health has long been recognized as a program area vulnerable to fraud, waste, and abuse. This Medicare…
Are There Advantages For Outsourcing The Entire Sanction-Screening Program?
Over the last decade, there has been a strong trend to outsource as many non-core business functions as possible. This…
How Can Internal Audit and Compliance Co-Exist and Coordinate?
Similarities Between Internal vs. Compliance Audits In many organizations, the Compliance Office and Internal Audit occupy similar space, leading to…
Update on Corporate Integrity Agreements
Compliance Program Reviews and Compliance Experts HHS OIG has recently demonstrated a new trend in Corporate Integrity Agreements (CIAs) it…
HHS OIG Reports Five-Fold Increase In Civil Monetary Penalties Over The Last Three Years
The HHS OIG issued its Semi-Annual Report for the first half of fiscal year (FY) 2016 (October through March). The…
OIG Evolving Positions on Compliance Program Standards are Well Publicized
No health care provider should be surprised about where its Compliance Program stands at any given time, as keeping current…
Physician Practice Corporate Integrity Agreements
Independent Review Organization (IRO) Scope of Work Mandates In 2015, the Department of Health and Human Services (HHS) Office of…
Corporate Integrity Agreements Mandate Boards to Retain a Compliance Experts
For several years, the OIG has gradually modified and enhanced CIAs to increase oversight and accountability of entities that agree…
Medicaid Expenditures Now Exceed Department Of Defense Budget
GAO actuaries estimated Medicaid expenditures at $529 billion The Government Accountability Office (GAO) reported to Congress that its actuaries estimated Medicaid…
OIG Describes Factors It Considers When Deciding On Sanctions
The OIG has the authority to exclude any individual or entity (collectively, “person”) from participation in Federal health care programs…
OCR Reports New Findings and Settlements While Beginning New Round of HIPAA Audits
OCR began its second round of HIPAA audits by notifying randomly selected Covered Entities and Business Associates (BAs) that they…