Hospitals and other health care providers typically rely on referrals from community providers as a major source of patients and revenue. The federal Stark and Anti-Kickback laws strictly regulate provider and facility a...

EXCLUSION LISTS DEMYSTIFIED Federal and state exclusion lists abound. There are two primary federal lists, which are addressed in this article, but to there are many other lists that should be considered when screenin...

The COVID-19 pandemic has changed the face of the health care industry on multiple fronts. These range from the multiple blanket 1135 temporary waivers issued by CMS that control how care for federal program beneficiarie...

Exclusion Background As noted in past blog posts, HHS OIG Exclusions are comprehensive and significant. Exclusion from participation in federal healthcare programs can have a profound effect on a provider’s healthcare...

As the first vaccines are delivered across the US, we can begin to look forward to a post-pandemic future and resuming routine activities that have been sharply curtailed in 2020.  This includes the resumption of the fu...

COVID 19 has resulted in a flurry of waivers by federal and state regulatory agencies related to the provision of health care for Medicare and Medicaid patients. The CMS blanket waivers (issued as “1135 waivers” unde...

Nurses and other health care providers must meet certain ethical standards in order to maintain their licenses. For example, in California, Welfare and Institutions Code §14043.6 and 14123, mandate that the Department o...

If the Affordable Care Act (ACA) is repealed – the potential effect on program integrity protections remains unclear. Over the last few years, the effect of an ACA repeal on health care and health plan coverage has ...

Streamline Verify considers itself fortunate to be running without incident throughout the COVID-19 pandemic due to the nature of its business. However, they have seen firsthand many of their own clients who are all heal...