OIG Finds Ineffective Controls In The Federal Marketplace To Verify Eligibility
In a recent blog I addressed a Government Accountability Office (GAO) report that described their ability to enroll fraudulently in…
“60 Day” Court Ruling Shocks Providers And Rings A Warning Bell To Compliance Officers
Tips and Suggestions from Experts The Affordable Care Act (ACA) mandated reporting and returning of overpayments within 60 days of…
CMS Establishes New Rules For Medicare Shared Savings Programs
The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule addressing changes to the Medicare Shared Savings…
OIG Finds That Barred Providers Are Still Billing Medicaid
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) reported that hundreds of Medicaid providers that…
Continued Questions About GSA Debarment Screening
Federal agencies can exclude (suspend or debar) businesses or individuals from receiving government contracts or assistance for various reasons. The…
CMS Proposes New Rule To Reduce Stark Law Burdens And Confusion
Recently, the Fourth Circuit Court of Appeals decided against the Tuomey Healthcare System in a case that has resulted in…
Evaluating Allegations of Wrongdoing
Although there are many channels of communication, compliance complaints and allegations arrive primarily through the use of hotlines. Complaints can…
Organizations Should Evaluate All Elements of a Compliance Program Through Employee Surveys
OIG Compliance Program guidance calls for effectiveness benchmarking of compliance programs and advises organizations to evaluate all elements of a…
Federal Court Rejects Tuomey Appeal: $234 Million Judgment Stands
The U.S. Court of Appeals for the 4th Circuit issued its decision in the decade long Tuomey Healthcare System fraud…
Tuomey: Case Study on Warning Signals and Tips on What Not to Do
After ten years of investigation, losing at two jury trials, and making multiple appeals, the Tuomey Healthcare case reached final…
OIG Calls For More Action To Reduce Medicare Part D Fraud
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a summary report documenting the results…
Tips On Physician Sanction Screening
Sanction screening physicians and other medical staff is not optional. Failing to sanction screen may result in a violation of…