IntroductionUnder Sections 1128 and 1156 of the Social Security Act (the “Act”), the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services (“HHS”) has authority to exclude fr...

DOWNLOAD PDF Streamline Verify has worked many organizations in the healthcare industry during our many years in business. In addition to health plans, hospitals, universities and physician groups, we are privile...

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 ve...

The Texas Office of the Inspector General for the state’s Health and Human Services agency recently published a reminder about the significance of exclusion screening. Texas, like many states, maintains a state exclusi...

Over the past 5 years, there has been a decreased in false claims recoveries by the DOJ. That trend was resoundingly reversed in fiscal year 2021. In a press announcement on February 1, 2022, the DOJ released the foll...

Background In 2013, the OIG issued an updated revised bulletin regarding the effect of exclusion from participation in federal programs. As part of that bulletin, the OIG addressed a number of somewhat gray areas incl...

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...