Healthcare organizations must screen against the OIG SAM databases to ensure they do not work with individuals or entities excluded from federal healthcare programs like Medicare and Medicaid. The Office of Inspector General (OIG) maintains the List of Excluded Individuals/Entities (LEIE), updated monthly, while the System for Award Management (SAM) tracks exclusions from federal contracts, updated annually.

In 2018, CMS released a report that set forth the results of their review of Medicare Advantage online provider directories. The review examined the accuracy of 108 providers and their listed locations selected from the online directories of 52 Medicare...

As providers of Medicare services, nursing homes rely heavily on the timely and accurate reimbursement from the government to ensure the provision of top-quality care to their residents. The negative financial implications of claim rejections due to inaccurate provider enrollment...

A recent and exciting CMS Medicare update for both benefit recipients and healthcare practitioners is that legislation that included expansion to mental health access was signed into law on December 29th, 2022. After several years of advocating and waiting, mental...

Health plans considering Medicare Advantage or Medicaid as a new line of business need to be well informed of the greatly enhanced oversight and requirements they will face compared to state regulation of commercial plans. The process for enrollment is...

In January of 2021 Centers for Medicare and Medicaid Services (CMS) announced that they would be auditing compliance with the National Background Check Program for Long-Term Care Providers. The National Background Check Program was enacted by legislation in 2010 to...

On January 1, 2019, the Centers for Medicare & Medicaid Services (CMS) introduced a new tool for Medicare plans – the CMS Preclusion List.  A previous article posted in 2018 provides an excellent overview of the new policy and process....

The COVID-19 pandemic has changed the face of the health care industry on multiple fronts. These range from the multiple blanket 1135 temporary waivers issued by CMS that control how care for federal program beneficiaries could be delivered and by...

As the first vaccines are delivered across the US, we can begin to look forward to a post-pandemic future and resuming routine activities that have been sharply curtailed in 2020.  This includes the resumption of the full accreditation and survey...