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Recent Additions to California’s Medi-Cal Exclusion Screening Databases

December 7, 2022

The California Medicaid program, known as Medi-Cal, is a highly regulated program by any measure. California takes a very intensive approach to assure that organizations offering services to Medicaid recipients meet a ve...

Data Analytics and Collaboration Drive Continued Success for Texas HHS-OIG

November 22, 2022

The 2022 Quarter Four Fiscal Report of the Texas Health and Human Services OIG was issued in September 2022 with highlights from another very successful year. The report reflects the continued focus of the OIG on enhance...

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....

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