State Enforcement of Medicare and Medicaid That Will Impact You

Compliance professionals often consider federal agencies such as HHS OIG or the U.S. DOJ when they worry about government investigations and enforcement action.

However, investigations and enforcement also frequently occur at the state level. For example, look at this update for Medicare and Medicaid Services from CMS:

“Title XXVII of the Public Health Service Act (PHS Act) contemplates that states will exercise primary enforcement authority over health insurance issuers in the group and individual markets to ensure compliance with health insurance market reforms. In the event that a state notifies the Centers for Medicare & Medicaid Services (CMS) that it does not have statutory authority to enforce or that it is not otherwise enforcing one or more of the provisions of title XXVII, or if CMS determines that the state is not substantially enforcing the requirements, CMS has the responsibility to enforce these provisions in the state.”

As you can see, CMS writes that states will exercise primary enforcement authority over health insurance issuers. CMS will step in as the enforcer if the state is not substantially enforcing requirements.

In this upcoming webinar on how states enforce non-compliance, compliance expert CJ Wolf, MD, will cover what you need to know to prevent issues in your organization. He will cover:

• Compliance enforcement efforts at the state level through Medicaid Fraud Control Units
• Activity by state level operated Offices of Inspector General
• Strategies for staying on top of state enforcement activities

 

The Compliance Certification Board (CCB^®) has approved this event for up to 1.2 live CCB CEUs based on a 50-minute hour. Continuing Education Units are awarded based on individual attendance records. Granting of prior approval in no way constitutes endorsement by CCB^® of this event content or of the event sponsor.
Please Note: This event has NOT been approved for AAPC CEU credit.