Part I: Who's Who in Enforcement Agencies
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In an era in which program integrity and the reduction of waste, fraud, and abuse have become increasingly a focus, it is important for health centers to familiarize themselves with the various government entities that conduct audits and investigations and their scope.
Due to their participation in multiple federal healthcare programs (for example, Section 330 of the Public Health Service Act, Medicaid, and Medicare), health centers are subject to scrutiny from a number of different sources, such as:
- HRSA’s Division of Financial Integrity
- Medicare Administrative Contractors (MACs)
- CMS’s Unified Program Integrity Contractors (UPIC)
- State Medicaid Fraud Control Units (MFCUs)
- Office of Inspector General (OIG)
While significant overlap exists between and among these entities, each has their own separate mission and motivation. In this webinar, we will introduce those entities, offer context to their roles, and explain their respective missions. This session will also highlight common risk areas for health centers that have arisen in the past in order to assist with a health center’s ongoing development of a compliance program and self-audit efforts.
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- Finance and Billing Personnel
- Compliance Officers
- Legal/General Counsel
By the end of this session, you will be able to:
- Identify which Government entities are typically involved in health center audits and investigations and understand their respective missions.
- Discuss common risk areas for health centers that have been subject to audits and investigations in the past.
- Update aspects of your compliance program and/or self audit efforts based on the identified common risk areas.
Kathy is a Partner in Feldesman Tucker’s health law practice group. In the area of health law, Kathy’s practice focuses on government-sponsored health care programs such as Medicaid, CHIP, Medicare, and the Affordable Care Act, with an emphasis on payment/reimbursement and compliance related issues. Kathy also represents clients in government investigations and audits, litigation before federal and state courts, as well as in administrative appeals with the U.S. Department of Health and Human Services Departmental Appeals Board (DAB) and Provider Reimbursement Review Board (PRRB). She provides reimbursement counseling (including identification, reporting, and repayment of overpayments) with respect to Medicare, Medicaid, and private third-party payors. [Full Bio]
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