In light of the historic health care fraud takedown announced by the DOJ and OIG on June 22nd, we’ve put together an infographic highlighting the important facts.
Risk Score Fraud in Medicare Advantage Plans
Medicare Advantage (MA) plans may be doing just what the name says- taking advantage of Medicare. It is highly unlikely that this was the intention in 2003 when MA plans…
CMS Enrollment Screening Will Prioritize Fraud Prevention
Protecting the integrity of the Medicare program is a top priority. Fortunately, the Affordable Care Act has allotted significant funding for task forces to root out fraud, waste and abuse.…
Stark Law and Strict Liability
The genesis of the Stark Law, also known as the Physician Self-Referral Law [42 U.S.C. § 1395nn], occurred in 1988 when a congressman named Pete Stark proposed the law to…
Overpayments: Reporting and Returning Deadline
The long awaited ruling on reporting and returning overpayments is now in the Federal Register and will become effective on March 14, 2016. As stated in §401.303, an overpayment is…
Jumpstart Your Compliance Program
The beginning of the New Year is a popular time for new initiatives. Many healthcare organizations are looking for ways to improve quality and reduce risk. A compliance program is…
Is Your Compliance Program Effective?
Having a compliance program in place is a start but having an effective compliance program is the goal. Proactively assessing the effectiveness of one’s own compliance program is better than…
Beware of Individual Liability: Yates Memo
On September 9, 2015, the Department of Justice (DOJ) Deputy Attorney General Sally Yates released a policy memorandum, titled “Individual Accountability for Corporate Wrongdoing,” also known as the “Yates Memo.”…
OIG WORKPLAN 2016
The Office of the Inspector General (OIG) is responsible for protecting the integrity of the programs in Health and Human Services against fraud, waste and abuse as well as recommending…
Overview of a Corporate Integrity Agreement (CIA)
Health care fraud recoveries for fiscal years 2009- 2014 exceeded previous records with five straight years of more than $2 billion in annual recovery from cases involving fraud and false…