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Deficit Reduction Act Compliance: Certification Requirements for New Jersey Providers & MCOs

November 9, 2022

Background on the DRA The federal Deficit Reduction Act of 2005 (DRA) included new requirements related to fraud, waste and abuse for Medicaid plans that received or made payments of $5 million dollars or more in any ...

WHAT EVERY HEALTHCARE EMPLOYER NEEDS TO KNOW ABOUT THE OIG EXCLUSION LIST

November 7, 2022

The Basics - Failure to Monitor Federal Exclusion Lists Can Hit Your Bottom Line Health care providers which serve Medicare and Medicaid enrollees have a duty to know if their employees, contractors or potential hire...

Some Medicaid Plans May Overstate Provider Network Adequacy

October 28, 2022

Medicaid patient access to care has been a challenge for years. Many providers have historically opted to not participate in Medicaid because of the low reimbursement rates and the increased administrative requirements t...

Fun and Smart Ways to Celebrate Compliance & Ethics Week

October 3, 2022

Adhering to compliance standards protects all consumers of healthcare services and ultimately enables the delivery of the highest levels of healthcare across the country. An annual Compliance Week provides a great opport...

Iowa MFCU’s Strong Performance in Combatting Fraud

September 19, 2022

In June, 2022, the OIG issued its 2021 Iowa Medicaid Fraud Unit (MFCU) Inspection Report. The OIG inspection revealed a MFCU unit with exceptionally strong case outcomes over the 2019-2021 period compared to other simila...

When Gift Cards May Not Constitute Inducement

September 14, 2022

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...

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