OIG Exclusion Screening

OIG Exclusion Screening.

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OIG LEIE AND GSA SAM/EPLS EXCLUSION LISTS

MEDICAID SANCTION LISTS FOR
39 STATES

MISCELLANEOUS
SANCTION LISTS

AUTOMATED UPDATES

Eliminate exclusion slip-ups for good. Streamline Verify automatically searches every employee, every month, notifying you of all new potential matches.

GUARANTEED COMPLIANCE

Fail-safe; foolproof. Our screening process includes all federal and state exclusion databases, going over and above OIG requirements.

PEACE OF MIND

We guarantee nothing less than 100% OIG compliance with our automated OIG Exclusion List screening. Our liability. Our responsibility. Our promise.

OIG EXCLUSION SCREENING’S MOST EFFECTIVE SOFTWARE…

BECAUSE COMPLIANCE SHOULD NEVER BE LEFT TO CHANCE.

RECENT OIG PENALTIES AND AFFIRMATIVE EXCLUSIONS




08-31-2016

Texas Pharmacy and Pharmacy Manager Settle Case Involving Excluded IndividualOn August 31, 2016, Lifechek 336 Pharmacy, LLC, Lifechek Staff Services, Inc., and Bruce Gingrich (collectively, “Lifechek”), Texas, entered into a $30,000 settlement agreement with OIG. The settlement agreement resolves allegations that Lifechek employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a store manager and pharmacy technician, provided items or services that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG.

08-19-2016

On August 19, 2016, in connection with the resolution of False Claims Act liability, John Balko & Associates, Inc. d/b/a Senior Healthcare Associates (SHA), agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that SHA knowingly and intentionally submitted or caused to be submitted claims for payment to Medicare for cerumen removal procedures, nail debridement procedures, and evaluation and management services using modifier-25, which were not medically necessary, were not authorized or requested by patients, were not supported by patient medical records, lacked required medical documentation, and/or were provided in reliance upon improper standing orders.

08-17-2016

After it self-disclosed conduct to OIG, Richland Memorial Hospital, Inc. (Richland), Illinois, agreed to pay $29,932.86 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Richland employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

08-12-2016

After it self-disclosed conduct to OIG, Buffalo Heart Group (BHG), New York, agreed to pay $13,084.73 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BHG employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

08-05-2016

After they self-disclosed conduct to OIG, Beth Israel Deaconess Hospital-Needham and Medical Care of Boston Management, Inc. d/b/a Affiliated Physicians Group (collectively, “BIDMC”), Massachusetts, agreed to pay $154,506.84 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BIDMC employed an individual that BIDMC knew or should have known was excluded from participation in Federal health care programs.

08-03-2016

After it self-disclosed conduct to OIG, Compliance Advantage, LLC (CAL), Kentucky, agreed to pay $32,249.15 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CAL employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

08-02-2016

On August 2, 2016, PHCC-The Pointe Rehabilitation & Healthcare Center LLC d/b/a The Pointe Rehabilitation and Healthcare Center, and PHCC-Paramount Health Care Company, LLC (The Pointe), Webster, Texas, entered into a $408,159.53 settlement agreement with OIG. The settlement agreement resolves allegations that The Pointe employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, an office manager, provided items or services to The Pointe patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.

After they self-disclosed conduct to OIG, UMass Memorial Health Care, Inc.; UMass Memorial Medical Center, Inc.; and the Clinton Hospital Association (collectively, “UMass”), Massachusetts, agreed to pay $30,299.27 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UMass employed an individual that UMass knew or should have known was excluded from participation in Federal health care programs.

07-27-2016

After it self-disclosed conduct to OIG, Fort Worth Manor Nursing Center (Fort Worth Manor), Texas, agreed to pay $113,820.91 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fort Worth Manor employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

07-26-2016

On July 26, 2016, Nexus Medical Services, Inc. (Nexus), and its owner, French McClung (McClung), agreed to be excluded from participation in all Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Nexus and McClung paid remuneration in the form of an inflated monthly rent payment to a physician’s practice to sublease a portion of the practice’s office space in exchange for referrals from the practice’s physician owner to Nexus. OIG also alleged that Nexus and McClung employed an individual that they knew or should have known was excluded from participation in Federal health care programs.

07-20-2016

On July 20, 2016, LXE Counseling, LLC (LXE), and its owner, Lexie Darlene George a/k/a Lexie Darlene Batchelor (Batchelor), agreed to be excluded from participation in all Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that LXE and Batchelor knowingly submitted claims to Medicaid for services not provided, services provided by unqualified individuals, telemedicine services not approved, as well as claims with falsified dates, codes, and lengths of service. Senior Counsels Kenneth Kraft and Nancy Brown represented OIG.

07-15-2016

After they self-disclosed conduct to OIG, Buckner Elam Medical (BEM) and Setal Rana, M.D. (Dr. Rana), Texas, agreed to pay $435,481.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BEM and Dr. Rana employed an individual that they knew or should have known was excluded from participation in Federal health care programs.

07-14-2016

On July 14, 2016, Pinnacle Hospice Care (PHC), Colorado, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that PHC employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual provided items or services to PHC patients that were billed to Federal health care programs. Senior Counsel Ellen Slavin represented OIG with the assistance of Paralegal Specialist Eula Taylor.

After it self-disclosed conduct to OIG, O’Connor Hospital, California, agreed to pay $207,698 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that O’Connor Hospital employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

07-12-2016

After it self-disclosed conduct to OIG, Carolina Kidney Associates, P.A. (CKA), North Carolina, agreed to pay $11,805.48 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CKA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

07-11-2016

Effective July 11, 2016, OIG excluded Bobby Merkle, MD, from participation in all Federal health care programs for a period of three years under 42 U.S.C. § 1320c-5 following a referral to the OIG by Kepro, the Beneficiary and Family Centered Care Quality Improvement Organization (QIO). OIG’s investigation determined Dr. Merkle violated his obligations to provide services to five Medicare beneficiaries: (1) when, and to the extent, they were medically necessary; (2) of a quality that met professionally recognized standards of care; and (3) supported by the appropriate evidence of medical necessity and quality in a form and fashion and at such time as they were required by the QIO. Dr. Merkle violated his obligations through prescription practices and choices of medications which violated professionally recognized standards of care, through documentation that did not support the proper management of chronic conditions or diseases in the patients, through failure to assess pain or response to treatment in patient with chronic pain, and for failure to document response to treatment or patient progress for pain, edema, or gastrointestinal upset. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.

07-07-2016

After it self-disclosed conduct to OIG, Palisades Health Care Partners, Inc. d/b/a ASAP Services Corporation (ASAP Services), District of Columbia, agreed to pay $66,647.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ASAP Services employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

07-06-2016

After it self-disclosed conduct to OIG, Gateway Healthcare, Inc. (Gateway), Rhode Island, agreed to pay $400,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Gateway employed three individuals that it knew or should have known were excluded from participation in Federal health care programs.

After it self-disclosed conduct to OIG, Natera, Inc. (Natera), California, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Natera employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

06-24-2016

On June 24, 2016, Simpson Chiropractic (Simpson), Oklahoma, entered into a $31,000 settlement agreement with OIG. The settlement agreement resolves allegations that Simpson employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a chiropractic assistant, provided items or services to Simpson patients that were billed to Federal health care programs. Senior Counsel Ellen Slavin represented OIG with the assistance of Paralegal Specialist Mariel Filtz.

After it self-disclosed conduct to OIG, Moses H. Cone Memorial Hospital Operating Corporation d/b/a Cone Health System (CHS), North Carolina, agreed to pay $475,220.66 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

06-23-2016

After it self-disclosed conduct to OIG, Community Care Physicians, P.C. (CCP), New York, agreed to pay $60,972.04 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CCP employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.

06-17-2016

After it self-disclosed conduct to OIG, UHS of Fairmount, Inc. d/b/a Fairmount Behavioral Health System (Fairmount), Pennsylvania, agreed to pay $58,339.74 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fairmount employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

06-10-2016

On June 10, 2016, Mark Goff, agreed to be excluded from participation in all Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Goff submitted or caused the hospital he co-owned and managed, to submit to the Medicare program false or fraudulent claims for Intensive Outpatient Program (IOP) psychiatric services. Senior Counsel Ellen Slavin represented OIG.

06-08-2016

On June 8, 2016, KASKA, Inc. d/b/a St. Otto’s Care Center (SOCC), Minnesota, entered into a $65,000 settlement agreement with OIG. The settlement agreement resolves allegations that SOCC employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a certified nursing assistant, provided items or services to SOCC patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.

A NECESSARY ADDITION TO EVERY COMPLIANCE OFFICER &
HR COORDINATOR’S EXCLUSION SCREENING TOOLKIT

THE SOFTWARE BUILT BY HR PEOPLE, FOR HR PEOPLE.

Streamline Verify is the effective and affordable solution that keeps your company OIG compliant, WITHOUT the tedious, labor-intensive data input requirements. Our automated OIG Exclusion List will save you time and money and make sure you stay compliant without any difficulty. Learn more about our hassle-free OIG Exclusion Screening software and discover how simple OIG compliance can be with Streamline Verify.

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TESTIMONIALS

  • “We’re delighted by how easily Streamline Verify has become an integral part of our operations. Our confidence levels in our screening have never been higher and our alert resolution processing has been enhanced dramatically. Plus, the learning curve is virtually non-existent – our staff has been comfortable using Streamline Verify since Day 1.” C. Joseph Kurland, Esq
  • “The “can do” attitude of the service and technical staffs at Streamline is truly remarkable. Streamline quickly adapted Streamline Verify to easily process the expanded number of uploads we required with a focus and a commitment to excellence that produced results and exceeded our expectations.” Cheri A. Copie, BSN, CHC, Director of Compliance and Regulatory Affairs NeoGenomics Laboratories
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