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 ...

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...

Background The Fair Credit Reporting Act (FCRA) was signed into law by President Nixon in 1970 and took effect April 25, 1971. The original purpose of the FCRA was to give consumers certain rights and protections rela...

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...

Mission and Structure: The mission of New York’s Office of the Medicaid Inspector General (OMIG) is to “to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusi...

Search the internet on OIG enforcement and you will eventually find articles about nurses, physicians, pharmacists and other licensed medical personnel and their travails related to OIG exclusion. A common theme running ...

Since 2017, the General Services Agency’s (GSA) Integrated Award Environment program office has been working to consolidate all related procurement tools into a single modernized online environment. The GSA manages fed...