OIG Crackdown on Home Health Providers
[dropcap]If[/dropcap] your agency is not performing both State and Federal OIG checks every month, now is a good time to start. Working with a provider or an employee that is on the OIG Exclusions list will put your agency at risk.[blockquote cite=”OIG”]For 2015, the OIG reported expected recoveries of more than $3 billion, which include $286.6 million in receivables recovered from agencies that employed providers on the OIG Exclusions list.[/blockquote]
In 2015 the OIG reported criminal and civil actions resulting in:
- Exclusions of 4,112 individuals and entities from participation in Federal healthcare programs
- 925 criminal actions against individuals or entities that engaged in crimes against HHS programs
- 682 civil actions
WHAT IS THE OIG’S FOCUS FOR LONG TERM CARE PROVIDERS IN 2016?
The OIG intends to examine reimbursements made to managed long-term-care (MLTC) plans and determine whether those reimbursements complied with certain federal and state requirements. If they do not comply with the requirements, the reimbursed agencies will be referred to Medicaid Fraud Control Units.
The OIG also intends to determine whether States and CMS (Medicare) checked exclusions databases for enrolling and enrolled providers. This is to prevent offenders from being part of the Medicare/Medicaid system and to deny or shutdown agencies that are on the OIG Exclusions list.
See the entire OIG 2016 Work Plan at the OIG website.
WHAT YOU NEED TO PROTECT YOUR AGENCY
- Create an effective compliance program
- Perform monthly OIG checks and create monthly reports
- Train staff on current home health requirements
- Keep abreast of home health regulation changes
- Detect any wrongdoings and correcting them quickly
WHAT CAN PENNI DO FOR YOU?
- Automatically check new or potential employees in the OIG Federal and State Exclusions lists
- Perform the OIG Federal and State checks each month on the day of your choice
- Notify you when an employee or provider appears on either the OIG Federal or State Exclusions list
- Create OIG monthly reports
- Store the results in Penni for easy access and safe keeping