Top 2016 Exclusions by the OIG

As we reflect on 2016, we wanted to provide a list of the top exclusions of the year, as examples of what the Office of Inspector General (OIG) and State Medicaid governing bodies are looking for in their audits. These are good lessons for all and range geographically from Puerto Rico to Wisconsin, and cover …


What is the Medicare Fraud Strike Force and what do they do?

The Medicare Fraud Strike Force (simply known as ‘Strike Force’), is an inter-agency team of state and federal law enforcement and health services bodies, whose key responsibility is to identify and crack down on fraud in the health care system. The strike force collects and analyses suspicious data from suspected perpetrators to identify suspicious billing …


5 factors that pose a challenge to OIG’s Protection of Medicaid Program from Fraud, Waste, and Abuse

Following the passing of the Patient Protection and Affordable Care Act (Affordable Care Act) into law, there has been rapid expansion of the Medicaid program in most states. By September 2015, 29 states and the district of Columbia had experience expansion of the program, both in the number of people served and money spent. This …


FBI databases not a reliable source of background information and could cause problems for employers

Employee background checks is a routine part of any screening process prior to employment. The aim behind these checks is to give employers the peace of mind that they are employing upstanding citizens, with no criminal record. There has been mounting pressure by state legislators for the inclusion of federal and state fingerprint checking as …


New Website to Be Used by Louisiana’s Medicare/Medicaid Providers for Adverse Actions Web Search.

Providers participating in the Louisiana Medicaid Program are prohibited from contracting with individuals or entities that have been excluded from the program.   It’s the responsibility of providers to ensure that current and potential employees, contractors and other agents and affiliates have not been excluded from participation in Medicaid or Medicare Programs, by Louisiana Medicaid or …