Insurers constantly look for ways both to attract new enrollees and to retain existing membership. The competition is stiff in many areas of the country, and there were instances historically where plans gave away ...
The Symbiotic Relationship of Federal and State Standards Related to Professional Licensing
September 5, 2022
Healthcare professional licensing and certification is controlled by states and local jurisdictions. All healthcare professionals must apply for licensure by the state (s) in which they intend to practice medicine....
HCFAC Turns 25 & Continues to Thrive in the Fight Against Fraud
August 23, 2022
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC or Program) under the joint direction of the Attorney General and the Secr...
The OIG Opines regarding Loaned Smartphones for Low Income Patient Access to Care
August 4, 2022
During the PHE, access to care was limited and social isolation was real. To increase access, the Centers for Medicare & Medicaid Services (“CMS”) through blanket waivers and state Medicaid programs tempora...
The Lone Star State’s Commitment to Exclusion Screening
July 22, 2022
The Texas Office of the Inspector General for the state’s Health and Human Services agency recently published a reminder about the significance of exclusion screening. Texas, like many states, maintains a state exclusi...
DOJ False Claims Highlights in 2021 and What to Expect Ahead
July 8, 2022
Over the past 5 years, there has been a decreased in false claims recoveries by the DOJ. That trend was resoundingly reversed in fiscal year 2021. In a press announcement on February 1, 2022, the DOJ released the foll...
Screening Volunteers Against Exclusion Lists – Things to Consider
June 30, 2022
Background In 2013, the OIG issued an updated revised bulletin regarding the effect of exclusion from participation in federal programs. As part of that bulletin, the OIG addressed a number of somewhat gray areas incl...
Updates on Data Modernization Efforts by the OIG
June 24, 2022
At the March 29, 2022 Health Care Compliance Association (HCCA) conference, Christi A. Grimm, HHS-OIG Inspector General, presented an update on key agency initiatives and priorities that directly impact health care and c...
COVID-RELATED FRAUD REMAINS A TOP LAW ENFORCEMENT PRIORITY
June 2, 2022
Even though COVID-19 seems to be receding in the minds of many, it continues to be the source of significant law enforcement actions at the federal level. COVID-related criminal investigations and prosecutions, from a fr...
