In a recently released MLN Matters (Number: SE1417), CMS announced that it is implementing the enhanced enrollment screening provisions of the Affordable Care Act (ACA) by requiring finger print based background checks for certain so called “high risk” providers. Currently this means that for newly enrolling Durable Medical Equipment, Prosthetic, Orthotic and Supplies (DMEPOS) suppliers and Home Health Agencies, individuals with a 5% or greater ownership interest in the provider or supplier will be subject to criminal background checks based on fingerprint identification. The procedure will also apply to providers that CMS has elevated to the high risk category pursuant to regulations. Affected providers will be notified by their MAC and be given 30 days to comply. The notification will identify contact information for the Fingerprint Based Background Check Contractor (FBBC). Continue reading
Posted in Community Based Care, Compliance Programs, Durable Medical Equipment, Employee Background Checks, Fraud and Abuse, General, Health & Human Services, Health Care, Health Care Providers, Health Reform, Home Health, Medicare, MLN Matters, Participation, Program Integrity, Provider Enrollment - Medicare, Regulation, Regulatory Compliance
The federal government has a wide array of sanctions it can levy against individuals and organizations that run afoul of the laws and regulations governing Medicare, Medicaid, and other federal healthcare programs.
One of its most effective tools is the ability to exclude persons convicted of certain criminal or civil violations from further participation in federal healthcare programs. Protecting your organization from individuals and entities that are excluded is an integral part of the operations of any organization that does business with federal health care programs.
Ari J. Markenson and Kelly Skeat discuss these issues in a recent article in the September issue of the Health Care Compliance Association’s Compliance Today magazine.
A copy of the article can be found here —> Protecting Your Organization From Exclusion Sanctions
Posted in Compliance Programs, Employee Background Checks, Exclusion, Fraud and Abuse, Health Care, Health Care Providers, Medicaid, Medicare, OIG, Payers, Program Integrity, Regulation, Regulatory Compliance
On May 8, 2013, the Office of Inspector General (OIG) issued an updated Special Advisory Bulletin (Updated Bulletin) on the effects of exclusion from participation in Federal health care programs. The Updated Bulletin replaces the original bulletin on the topic issued in September 1999. The Updated Bulletin describes the scope and effect of the legal prohibition on submitting a claim or receiving a payment from a Federal health care program for items or services furnished: a) by an excluded person; or b) at the medical direction or prescription of an excluded person. An excluded person is a person whom the OIG has excluded from participation in Medicare, Medicaid, and other Federal health care programs after finding that the person has engaged in fraud, abuse, or other misconduct relating to Federal health care programs. Continue reading
Posted in Compliance Programs, DHHS, Employee Background Checks, Exclusion, Fraud and Abuse, Health & Human Services, Health Care, Health Care Providers, Health Care Workers, Medicaid, Medicare, OIG, Program Integrity, Regulatory Compliance
On September 27, 2012, the US Department of Health and Human Services Office of the Inspector General’s (“OIG”) Office of Evaluation and Inspections issued a report (OEI-07-09-00632) entitled “Excluded Individuals Employed by Providers Enrolled in Medicaid Managed Care Entities”.
Identifying excluded individuals that are connected to the Medicare and Medicaid programs has traditionally been low-hanging fruit for the government. It is an easy issue to prove and the recoveries can be significant. This study is just one more example of the OIG’s focus on an easy area for enforcement.
You can find a discussion of what excluded individuals are and how to avoid the issue in our Benesch Issue Brief entitled “Individuals Excluded from Federal Health Care Programs or Federal Contracting: Protecting Your Organization” Continue reading
Posted in Compliance Programs, Employee Background Checks, Exclusion, Fraud and Abuse, Health Care, Health Care Providers, Medicaid, OIG, Payers, Program Integrity, Regulatory Compliance