Recently, the OIG modified the provisions and requirements of several corporate integrity agreements (CIA). In addition to having direct impact on those organizations subject to such agreements, these changes also provid...
Updated Guidance on Exclusion Screening for New Jersey’s Medicaid Providers and Plans
February 15, 2023
In January of 2023, New Jersey issued new guidance regarding those databases that healthcare entities (including providers and managed care organizations) participating in NJ’s Medicaid program must query monthly to ve...
Recent Additions to California’s Medi-Cal Exclusion Screening Databases
December 7, 2022
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...
Data Analytics and Collaboration Drive Continued Success for Texas HHS-OIG
November 22, 2022
The 2022 Quarter Four Fiscal Report of the Texas Health and Human Services OIG was issued in September 2022 with highlights from another very successful year. The report reflects the continued focus of the OIG on enhance...
Deficit Reduction Act Compliance: Certification Requirements for New Jersey Providers & MCOs
November 9, 2022
Background on the DRA The federal Deficit Reduction Act of 2005 (DRA) included new requirements related to fraud, waste and abuse for Medicaid plans that received or made payments of $5 million dollars or more in any ...
Fun and Smart Ways to Celebrate Compliance & Ethics Week
October 3, 2022
Adhering to compliance standards protects all consumers of healthcare services and ultimately enables the delivery of the highest levels of healthcare across the country. An annual Compliance Week provides a great opport...
The OIG Opines regarding Loaned Smartphones for Low Income Patient Access to Care
August 4, 2022
During the PHE, access to care was limited and social isolation was real. To increase access, the Centers for Medicare & Medicaid Services (“CMS”) through blanket waivers and state Medicaid programs tempora...
DOJ False Claims Highlights in 2021 and What to Expect Ahead
July 8, 2022
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...
Updates on Data Modernization Efforts by the OIG
June 24, 2022
At the March 29, 2022 Health Care Compliance Association (HCCA) conference, Christi A. Grimm, HHS-OIG Inspector General, presented an update on key agency initiatives and priorities that directly impact health care and c...
