Indeed, it was another “Dantastic” Monday as Inspector General Dan Levinson took the podium to deliver the keynote at the 21st Annual Compliance Institute in National Harbor, Maryland.
Dan opened with the discussion of a January Health Care Compliance Association (HCCA) U.S. Department of Health and Human Services Office of Inspector General (HHS/OIG) roundtable meeting of a “horizontal collection of expertise to help come up with a very valuable product”.
The document was created as a result of the discussion at the January 17, 2017 meeting: “Measuring Compliance Program Effectiveness”. The Guide contains 500 tips and resources for compliance professionals to work with in establishing the effectiveness of a compliance program.
The seven divisions of the Guide are based on the seven compliance program elements of an effective compliance program:
Compliance professionals are encouraged to target the element of the guide to their professional need in their organization and to “keep in mind the importance of incremental gain”.
Also noted during the keynote was the OIG’s attention to key problem areas including prescription drug abuse, home health services and Medicaid program integrity.
Home health services were described as “part of the new landscape in healthcare”. Monitor Monday listeners have been regularly updated on the Illinois pre-claim demonstration (currently halted) and the pending implementation in Florida (currently on hold). The reason for the pre-claim review demonstration is in part to stem the rampant fraud and abuse in the submission of claims for home health services.
Dan mentioned a False Claims Act (FCA) case of $375 million wherein a physician in Texas was taking advantage of the home health benefit to submit false claims.
Medicaid program integrity, according to Dan’s comments, is “becoming more opaque” in that more Medicaid programs are moving to managed care and it becoming more difficult to ensure that tax payor dollars are used appropriately. For example, are providers qualified? Is the population being service appropriately? A key area of concern is the personal care services area, wherein Dan cited a case that an attendant failed to watch the Medicaid beneficiary and the beneficiary “turned up dead”. He referred attendees to the OIG Advisory on attendant services.
Dan closed his remarks by commenting on the significant OIG “cover” at the Compliance Institute operating in the themes of prevention, detection and enforcement.
Inspector General Dan Levinson
What should you do if you get an email with the subject line “U.S. Office of Inspector General HHS – Special Investigations?” A doctor I’m
Price transparency in healthcare has long been a stated priority for the Trump Administration, both the first and second, and several recent public moves have
Please log in to your account to comment on this article.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Stay ahead of Medicare Advantage’s 2025-2026 regulatory changes in this critical webcast featuring expert Tiffany Ferguson, LMSW, CMAC, ACM. Learn how new CMS rules limit MA plan denials, protect hospitals from retroactive claim reopenings, and modify Two-Midnight Rule enforcement—plus key insights on omitted SDoH mandates and heightened readmission scrutiny. Discover actionable strategies to safeguard revenue, ensure compliance, and adapt to evolving health equity priorities before the June 2025 deadline. Essential for hospitals, revenue cycle teams, and compliance professionals navigating MA’s shifting landscape.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
