In CMS
Jul 13th, 2017
The Office of Inspector General’s (OIG) combat on healthcare fraud, waste, and abuse of taxpayer’s money recovers $5 for every $1 spent on investigating, which gives them incentive to target more areas of fraud. The OIG’s latest and largest fraud takedown happened this month when opioid fraud was exposed with the help of state and federal law ...
Keep calm, know your responsibilities and risks, have a plan, and carry on. If your physician office receives a request for records from a health plan’s special investigations unit (SIU), your best defense is knowing the options, responsibilities, and duties attached to the request. Understand the SIU and FWA The SIU is part of the ...
Put these OIG compliance efforts on a high priority focus list for your provider. The Office of Inspector General’s (OIG) annual work plan for 2016 outlines significant new areas, as well as ongoing target areas, on which the federal agency will focus its reviews and audits of U.S. Department of Health and Human Services (HHS) ...
The Yates Memo provides a renewed focus on individual accountability in corporate misconduct. By Robert Pelaia, Esq., CPC, CPCO, and Jamie Ewing Note from Editor: There is a follow-up article to this article. On September 9, 2015, Sally Q. Yates, the current deputy attorney general for the United States Department of Justice (DOJ), issued a guidance ...
In Audit
Jan 27th, 2016
CenterLight Health Care, formerly Beth Abraham Family of Health Services, has agreed to repay a combined $47 million to state and federal authorities after admitting to having over 1,000 ineligible members in its Medicaid-sponsored long term care plan. The Medicaid-funded care plan required that the members be in need of nursing home care to qualify. ...