Blog

The Role of Delegated Entities in Exclusion Screening

December 14, 2021

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 ...

Employers – Dig Deeper! The Role of Abuse Registries in Employee Screening

November 24, 2021

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...

Exclusions Due to Overpayments – Cautionary Tales

October 25, 2021

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...

Vendor Management is a Risky Business

October 18, 2021

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...

The Impact of FCRA and FACTA on Exclusion Screening

August 30, 2021

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...

CORPORATE INTEGRITY AGREEMENTS – AN OFFRAMP ON THE ROAD TO EXCLUSION

July 5, 2021

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...

NEW YORK STATE’S OMIG & MEDICAID EXCLUSIONS

April 5, 2021

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...

The Often-Unknown Impact of OIG Exclusions

March 8, 2021

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 ...

SAM.gov Continues to Evolve

March 1, 2021

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...

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