Tag Archives: oig

South Carolina Medicaid Overpaid Hospitals for Some Inpatient Services That Medicare Paid

South Carolina overpaid some Medicaid inpatient claims from hospitals that had received Medicare payments for the same services. Of the 1,136 overpayments ($2.3 million Federal share) that we reviewed, the hospitals had refunded 532 prior to our audit. However, the … Continue reading

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Durable Medical Equipment Clinic Owner Sentenced for His Role in $11 Million Health Care Fraud Scheme

The former owner of a defunct durable medical equipment (DME) clinic was sentenced today in Miami to serve 70 months in prison for his role in an $11 million health care fraud scheme involving World Class Medical Clinic Corp. (World … Continue reading

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New York State Made Unallowable Medicaid Fee-for-Service Payments

NEW YORK STATE MADE UNALLOWABLE MEDICAID FEE-FOR-SERVICE PAYMENTS FOR BENEFICIARIES ALSO ENROLLED IN MEDICAID MANAGED CARE The New York State Department of Health (State agency) did not prevent separate Medicaid fee-for-service payments from being made for beneficiaries also enrolled in … Continue reading

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OIG Compliance Guidance Documents

OIG has developed a series of voluntary compliance program guidance documents directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers, to encourage the development and use of internal … Continue reading

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Compliance 101 Education Materials

Welcome to OIG’s Compliance 101 Web page. OIG developed the free educational resources listed on this Web page to help health care providers, practitioners, and suppliers understand the health care fraud and abuse laws and the consequences of violating them. … Continue reading

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Office of Inspector General (OIG) – US Dept. of Health & Human Services

The Office of Inspector General’s (OIG) mission is to protect the integrity of the Department of Health & Human Services (HHS) programs as well as the health and welfare of program beneficiaries. Since its 1976 establishment, the OIG has been … Continue reading

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THE HEALTH CARE DIRECTOR’S COMPLIANCE DUTIES: A Continued Focus of Attention and Enforcement

A Joint Publication from the Office of the Inspector General, U.S. Department of Health and Human Services and the American Health Lawyers Association http://oig.hhs.gov/compliance/compliance-guidance/docs/Health_Care_Directors_Compliance_Duties.pdf

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Christus Saint Vincent Regional Medical Center Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

Christus Saint Vincent Regional Medical Center, in Santa Fe, New Mexico, (the Hospital) did not comply with Medicare requirements for billing Kwashiorkor on any of the 115 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor, but … Continue reading

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OIG Advisory Opinion – Monthly Exclusion Database Checks for Employees

The OIG recommends that providers screen all covered employees and contractors at least monthly. The OIG maintains a List of Excluded Individuals and Entities (LEIE) and updates their database every month.  Accordingly, the OIG expects providers to screen monthly to … Continue reading

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