Under federal law, Medicare Advantage plans and Part D plan sponsors may delegate administrative or healthcare service functions to third parties, such as a medical group, pharmacy benefit manager, claims administration ...

Introduction The 2021 Top Management and Performance Challenges Facing HHS is an annual publication of the Department of Health and Human Services (DHHS) Office of Inspector General (OIG). The OIG has identified six t...

When most people think about pharmaceutical fraud, they may envision pharmacy staff shorting a prescription to pocket a few pills and then overcharging the patient, or taking pharmacy inventory to sell on a shady interne...

There are specific screening requirements for health care employers who receive federal funds as participants in federally-funded health care programs, but screening against abuse registries is an often-overlooked resour...

While it seems unlikely that an organization’s mail management can result in exclusion from a federally funded program, many errors seem to be causing major headaches for well-intentioned, high- performing organization...

Screening employees and potential hires against federal and state exclusion lists can be relatively straightforward if an organization’s HR department maintains current employee data and utilizes the services offered b...

On September 9, 2021, President Biden issued Executive Order 14042 (“Order”) which mandated that federal contractors provide adequate COVID-19 safeguards to their workers performing on or in connection with a federal...

Medical transportation companies have been on federal and state regulatory radar for decades, for program integrity concerns such as fraudulent billing practices and patient safety concerns. Currently there are 812 names...

In April of 2021, defendants Stephanie Fleming and Helen Storey were convicted of multiple counts of health care fraud in federal district court in Florida. The defendants were found guilty of conspiracy to commit health...