Federal exclusion requirements have been in place for years. However, in the last decade there have been significant legislative efforts to strengthen and extend Medicaid program integrity controls to protect beneficiari...

Background The function of Medicaid Fraud Control Units (MFCUs/Units) is to investigate and prosecute Medicaid provider fraud and patient abuse/neglect. The Social Security Act requires each state to operate a MFCU. M...

Without question, the COVID-19 pandemic profoundly affected the health care industry. In some cases, the effects were fleeting, such as hospital over-crowding and supply chain challenges related to masks, oxygen and vent...

The COVID-19 pandemic drove significant changes and expansion in care delivery practices. The federal government and the State of Texas implemented policy and treatment flexibility to ensure continued access to care and ...

When a health care entity is faced with permissive exclusion from participation in federal health care programs, the Health and Human Services Office of Inspector General (OIG) has the discretion to offer a Corporate Int...

Beginning in 2021, both the HHS OIG and the DOJ have leveraged their resources to focus to the fraud and abuse schemes against federal health care recipients and programs related to the COVID-19 pandemic. As the pandemic...

Every year, hundreds of health care providers and entities receive notification from the HHS OIG that they are being considered for exclusion from participation in federal programs. To date in 2021, 684 individuals and e...

The first COVID-related federal stimulus payments were sent in the spring of 2020. Unfortunately, payments were sent to millions of taxpayers who were deceased at the time of payment. Not only did this draw attention ...

Introduction For most health care organizations, their primary purpose is to provide high quality patient care to support the best outcomes possible.  The qualifications and expertise of an organization’s medic...