Florida OIG Exclusion

Posted by Frank Strafford on July 5, 2016 in Exclusion Screening, Exclusions,

Florida Healthcare Exclusion

Florida OIG Exclusions

Under the State of Florida’s Agency for Health Care Administration (AHCA) is the Office of the Inspector General, spearheaded by Chief Kelly Bennett. As an integral part of the AHCA, the Office of the Inspector General “provides a central point for coordination of and responsibility for activities that promote accountability, integrity, and efficiency,” and functions in keen pursuant to Section 20.055 of the Florida Statutes.

The Office of the Inspector General actively fosters its core mission: “To assist the Secretary and other Agency management in championing accessible, affordable, quality healthcare for all Floridians by assessing the efficiency and effectiveness of health care administration resource management.”

This mission is carried out through an array of functions, including:

  •         Independent examination and evaluation of Agency programs, activities, and resources.
  •         Internal investigations of alleged violations of Agency policies, procedures, rules or laws.
  •         Investigation of suspected fraud and/or abuse of the state’s Medicaid program.

The Office of the Inspector General supervises four units: Internal Audit, Investigations, HIPAA Compliance Office, and Medicaid Program Integrity.

The Medicaid Program Integrity office exists pursuant to Section 409.913, Florida Statutes. Its main objective is the investigation of providers suspected of fraud or abuse of the state’s Medicaid program. Other functions of this office include:

  •         Recovery of overpayments
  •         Issuance of administrative sanctions
  •         Referral of fraud-related cases to the Office of the Attorney General for criminal investigation

Through the sustained efforts of the Medicaid Program Integrity under Florida’s Office of the Inspector General, $905 million recoveries have been made from 2008 to 2015. In FY 2014-15, a total of $34,234,735.00 was made in both civil and criminal cases.

For reports of suspected fraud, contact the MPI’s hotline at 1-888-419-3456 or Complete a complaint form online.

Some Florida OIG Exclusion Stats:

  • A total of 6,347 individuals and/or entities from Florida have been listed on the List of Excluded Individuals/Entities since 1978.
    • This includes 734 total number of businesses on the LEIE.
  • 1,939 listed on the LEIE from Florida for the years 2010-2015 which is about 7% decrease from the previous period of 2,070.  
  • Exclusions include among others:
    • Entities controlled by a family or household member of an excluded individual and where there has been a transfer of ownership/ control.
    • Default on health education loan or scholarship obligations.
    • License revocation or suspension.
    • Felony conviction relating to health care fraud.
  • Specialties with OIG exclusions among others are:
    • Bookkeeper
    • Administrators
    • Billing Dept.
    • Chiropractor
    • Audiology
    • Dental
    • Home care
    • Nephrology
    • Plastic Surgery

http://ahca.myflorida.com/Executive/Inspector_General/medicaid.shtml

http://ahca.myflorida.com/Executive/Inspector_General/

http://ahca.myflorida.com/Executive/Inspector_General/docs/Medicaid_Fraud_Abuse_Annual_Reports/2014-15_MedicaidFraudandAbuseAnnualReport.pdf

http://oig.hhs.gov/exclusions/exclusions_list.asp   

Please refer to this resource for more helpful information on OIG Exclusions and LEIE searches.

Check out this great resource for all questions on the Florida OIG Exclusion List.

About Frank Strafford

About Frank Strafford

Related Articles

Driving Healthcare Costs Down, By Bringing ...

January 4, 2016

  Why does medical care cost so much, anyway? Dumb question.  It doesn’t take a rocket scientist to understand that healthcare costs.  Treatments cost, prescriptions cost, equipment costs. ...

A MESSAGE FROM OUR CEO

July 13, 2020

Dear Valued Partners,I hope this letter finds you and your loved ones safe and in good health during this relentless pandemic.COVID-19 has given our team an even deeper appreciation and reverence for ...

Fraud Fallout from the Pandemic

July 19, 2021

Without question, the COVID-19 pandemic profoundly affected the health care industry. In some cases, the effects were fleeting, such as hospital over-crowding and supply chain challenges related to ma...

Understanding OIG Exclusions

OIG Exclusions Screening Process

Exclusion FAQS

Quick OIG Exclusion Basics

Employing Excluded Individuals

Consequences to Employing an Excluded Individual

OIG Compliance Law

Laws and Publications on OIG Compliance

More Compliance Resources

Our Culture

We build the best, so you can perform at your best.

Trusted for Good Reason

  • ✓ Guaranteed accurate
  • ✓ Certified Secure
  • ✓ Audit Proof
  • ✓ Feature-rich reporting
  • ✓ Round the clock real-time-data
  • ✓ Processing fully automated

Security First

  • ✓ Cloud hosted
  • ✓ Encrypted data
  • ✓ Real-time backups

Trusted for Accuracy

  • ✓ Physical security
  • ✓ Restricted access
  • ✓ Single sign-on
  • ✓ Password security
  • ✓ Certified secure
  • ✓ Cross checking

HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY

5

60%

Average workload reduction by implementing the Streamline Verify program

5

10K

Establishments trust Streamline Verify nationwide

5

2011

Serving the healthcare industry’s unique compliance needs since 2011

5

24X

Setting standards with hourly synchronization to primary source data