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
The 30th Annual Compliance Institute for the Health Care Compliance Association (HCCA) is scheduled to take place in Orlando next week. If you are there,
Sometimes you want to be contacted by the US Department of Health and Human Services (HHS) Office of Inspector General (OIG). I realize that
Please log in to your account to comment on this article.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Celebrate Lab Week with MedLearn! Sign up to win one year of our Laboratory All Access Pass! Click here to learn more →
Have a Medicare regulation question you’d love Dr. Hirsch to answer? Now is your chance! CLICK HERE to learn more→
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. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
