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Category Archives: Medicaid

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An Opportunity for the OIG and Providers

By Frank Sheeder on Posted in Administration, Enforcement, Government Initiatives, Medicaid, Medicare, OIG, Settlements

The HHS-OIG has published a Federal Register notice asking for comments to its 14 year-old Provider Self Disclosure Protocol.  This is a great opportunity for providers to make their voices heard.  We are thinking about making some comments.  Feel free to contact me if you are interested in participating. In my opinion, the Protocol is… Continue Reading

Do Not Pay: The Government’s Newest Tool

By Frank Sheeder on Posted in Administration, Government Initiatives, Medicaid, Medicare, RACs

In previous posts and presentations, I have emphasized the critical role that data prospecting will play in the government’s efforts to prevent health care fraud, waste and abuse.  Here’s further support for the proposition.   The Office of Management and Budget has created a new tool called Do Not Pay.   It is complemented by a… Continue Reading

The Mixed-Up Audit MICs

By Frank Sheeder on Posted in CMS, Enforcement, Government Initiatives, Medicaid, OIG, RACs, Uncategorized, Waste

The Department of Health and Human Services – Office of Inspector General (HHS-OIG) recently released a report entitled Early Assessment of Audit Medicaid Integrity Contractors.  The OIG assessed the efforts of the Audit Medicaid Integrity Contractors (Audit MIC) to identify overpayments in Medicaid.  The findings show that the audit process was broken and resulted in… Continue Reading

12 Enforcement and Compliance Predictions for 2012

By Frank Sheeder on Posted in Culture, DOJ, Enforcement, Government Initiatives, ICD, Implantable Cardiac Devices, Long Term Care, Medicaid, Medicare, OIG, Reform, Settlements

This has been an interesting year for the health care industry, and I believe the coming year will be even more exhilarating.  Here are my 12 enforcement and compliance predictions for 2012.  Please comment with yours.  We’ll see how we do. . . .   Regardless of what happens with the health care reform law, the current market forces… Continue Reading

A 10-Year Old’s View of Health Care Enforcement

By Frank Sheeder on Posted in DOJ, Enforcement, Fraud, Medicaid, Medicare, OIG, Reform

My Daughter’s Depiction of Health Care Enforcement — I Call it Enforcica  — One of the more challenging and rewarding aspects of being a health care attorney is taking a complex regulated environment and breaking it down in a way that is understandable, regardless of the audience.  In the compliance world, this means communicating the rules… Continue Reading

Medicaid RACs: Tool of transparency or torment?

By Frank Sheeder on Posted in Enforcement, Government Initiatives, Medicaid, RACs

The Medicaid RACs are coming soon, and prudent providers are getting ready for life in the formicarium (translated:  ant farm). My colleage and blog co-editor, Rebecca Jones McKnight, wrote a clever and interesting Feature Focus in the December 2011 issue of the Health Care Compliance Association’s monthly publication, Compliance Today.  She wonders whether CMS is… Continue Reading

Heads Up! HHS-OIG is Emphasizing Medicaid Enforcement

By Frank Sheeder on Posted in Enforcement, Government Initiatives, Medicaid, OIG, Uncategorized

I have been saying for a while that there will be a renewed emphasis on Medicaid enforcement.  Here’s some more objective evidence of this trend:  The HHS-OIG has published Proposed Revisions of Performance Standards for State Medicaid Fraud Control Units. The current standards were promulgated in September 1994, in the aftermath of the last big health care… Continue Reading

Medicaid RACs Will Soon Spring to Life: Another Head Grows on the Hydra of Government Oversight and Inquiry

By Frank Sheeder on Posted in Government Initiatives, Medicaid, RACs, Reform

Here is a good summary of the new Medicaid RAC regulations.  Thanks to my colleague Becca McKnight for putting it together.  The original appears on DLA Piper’s Health Care Law Matters Blog. Contributed by Frank E. Sheeder III and Rebecca Jones McKnight as part of our ongoing Fraud & Abuse Matter series. Health care providers may… Continue Reading

View the OIG HEAT Provider Compliance Training Webcast

By Frank Sheeder on Posted in Administration, Enforcement, False Claims Act, Fraud, Government Initiatives, Medicaid, Medicare, OIG, Reform

OIG has posted a webcast of its HEAT Provider Compliance Training.  It is 3 hours, 45 minutes long.  I will post a summary in the near future.  There is also an OIG HEAT Provider Compliance Training Website at which you can download the corresponding slides and related materials. Get Instant Updates by Email

OIG’s HEAT Provider Compliance Training

By Frank Sheeder on Posted in Administration, CMS, DOJ, Enforcement, False Claims Act, Fraud, Government Initiatives, Medicaid, Medicare, OIG, Stark Law

Since February 2011, members of the HHS Office of Inspector General (OIG) and their colleagues have been presenting HEAT Provider Compliance Training across the country.  The most recent training included a live webcast with slides.  The OIG has committed to posting a link to the webcast by the end of May.  In the meantime, the slides… Continue Reading