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Category: Medicare

Provider Termination FAQs

By support@poweredbygnosis.com

Sanctions, Exclusions, Terminations, Suspensions, and Debarment are administrative actions taken against an individual or entity by the Office of Inspector General (OIG), State Healthcare Program Agencies, the Medicaid Fraud Control Unit (MFCU), or one of the many agencies associated with the General Services Administration (GSA), for reasons that include fraud, integrity, or quality. For healthcare organizations, an individual or entity that is sanctioned or excluded by the OIG, terminated by a State Healthcare Program authority, or suspended or debarred by the GSA is prevented from participating in any Federal Healthcare Reimbursement Program, including Medicaid, CHIP, and Medicare programs, regardless ofLearn MoreProvider Termination FAQs

Medicaid Exclusions, Sanctions, Terminations – What’s the Difference?

By support@poweredbygnosis.com

The differences between sanctions, exclusions, and termination are crucial for healthcare organizations to understand when hiring and retaining skilled professionals. Sanctions A sanction results from an administrative hearing where an individual or entity violates an administrative rule, civil law, or criminal offense, leading to various penalties. Sanctions are enforced by the Office of the Inspector General (OIG) or a State Medicaid program authority. A sanction from a healthcare disciplinary or licensing board can lead to significant consequences, the most severe of which is an exclusion. Exclusions An exclusion results from an extreme sanction issued by the Office of Inspector General (OIG). Exclusions areLearn MoreMedicaid Exclusions, Sanctions, Terminations – What’s the Difference?

How to File a Complaint with Medicare

By support@poweredbygnosis.com

Medicare receives over 100,000 complaints annually. You’re not alone if you’re dissatisfied with any aspect of the federal healthcare program. You might be wondering how to express your concerns. Frequently Asked Questions What is a grievance with Medicare? A Medicare grievance is a patient’s dissatisfaction with any aspect of a health care provider’s service or even the health care plan itself. It can be for reasons such as an inability to schedule an appointment with an approved Medicare provider or feeling like you were treated poorly by a doctor, nurse, or other medical staff member. How do I file aLearn MoreHow to File a Complaint with Medicare

Exclusion Lists FAQs

By support@poweredbygnosis.com

Which exclusion list should I use to check employees and vendors, the OIG-LEIE or the GSA-SAM? It is recommended that you check both the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) and the General Services Administration’s (GSA) System for Award Management (SAM) databases, as well as all of the publicly available State Exclusion Lists. According to 42 CFR Part §455.436(b) — Federal database checks, State Medicaid agencies must: (b) Check the Social Security Administration’s Death Master File, the National Plan and Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE), the System for AwardLearn MoreExclusion Lists FAQs