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 very high level of service and quality. The...
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 enhanced data analytics to...
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 fiscal year. Section...
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 hires have been excluded by the...
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 that Medicaid plans entail. A recent study found...
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 opportunity to change your workers’ attitudes towards compliance, educate...
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 similarly-sized state units. For the federal...
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 valuable merchandise such as child car...
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. In 2020, about 14.3 million U.S. healthcare workers were subject...
