Ohio Medicaid Provider Exclusion and Suspension List The Ohio Department of Medicaid (ODM) was founded in July 2013. It is the premier Executive-level Medicaid agency of the state of Ohio. Led by Director John B. McCarthy and in partnership with...
Compulsory Exclusion Screening at the Federal and State Level
February 16, 2016
Exclusion Screening 101 Exclusion screening occurs at both the federal and state levels. The federal government maintains two principal exclusion databases, the Office of the Inspector General (OIG)’s LEIE database and the System for Award Management (SAM.gov) database. It...
OIG Exclusion Made EASY
February 9, 2016
The U.S. Department of Health and Human Services established The Office of Inspector General (OIG) to carry out these basic functions: The identification and elimination of fraud, waste, and abuse of the programs initiated by the U.S. Department of Health...
A Taste of Their Own Medicine – Pharmacists Defrauding the Healthcare System…and getting caught
February 4, 2016
Medicaid and Medicare frauds run to the tune of billions of dollars each year. Running a check on OIG exclusions is one way to catch this fraud, and also protect one’s healthcare system from doing business with blacklisted entities and individuals....
The Baby-Boomer Effect: How Healthcare Fraud is Turning Grey
January 18, 2016
The National Healthcare Anti-Fraud Association approximates 3 to 10 percent of annual healthcare expenditures account to fraudulent claims. This means that in the $600 billion spent for Medicare back in 2012, $60 billion was lost to healthcare fraud. This...
Powerball and The Compliance Officer
January 13, 2016
The exhilaration of tonight’s $1.5 billion Powerball drawing is attracting even people who don’t typically play the lottery. And, in many organizations, employees are pooling their resources with the promise of splitting the windfall from a winning ticket. However, buying...
2015: OIG Compliance Year in Review
January 6, 2016
How did healthcare compliance fare in 2015? Overall, it was quite a busy year for the OIG and various organizations, with noteworthy settlements and enforcement activities beginning as early as January. The OIG excluded 4,112 individuals and entities from participation...
Driving Healthcare Costs Down, By Bringing OIG Compliance Up
January 4, 2016
Why does medical care cost so much, anyway? Dumb question. It doesn’t take a rocket scientist to understand that healthcare costs. Treatments cost, prescriptions cost, equipment costs. Everybody knows that. Not everybody knows that bloopers cost. Big time. The...
The “To-Don’t” List of OIG Compliance
December 29, 2015
OIG Compliance requires a lot of things to remember. However, since many people respond more pro-actively when they learn of the possible consequences, here is a short “to-don’t” compliance list instead of the usual “to-do”. Don’t be complacent about your...
