If you are in the healthcare business, you should be familiar with the Office of Inspector General (OIG) Exclusions List. The list is made up of individuals and entities which are excluded from federally funded health care programs.
As stated in the “Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs,” which was published in May of 2013, federal money cannot pay for anything provided by:
- At the medical direction of or on the prescription of an excluded person
This applies too all programs regardless of the form of payment and includes services from an excluded person that are billed as part of a payment to a person or entity not excluded. In additional to direct care of patients, the exclusions cover things such as:
- Preparation of surgical trays
- Review of treatment plans
- Entering prescription information for pharmacy billing
- Administrative/management services
While the list is not all inclusive, it gives a good snapshot of how wide the span of coverage for exclusions is. Health care providers who employ, hire as a volunteer, or work in any way, including hiring through an agency, with anyone they know or should know is on the OIG excluded list can be fined up to $10,000 for each item or service provided by the excluded individual, in addition to other potential fines. As you can see, this can be very costly and could also result in the company being excluded from federally funded programs.
So, what does this mean for employers who are in the health care industry? Health care entities typically check exclusions lists for applicants before hiring, but many fail to conduct follow-up checks as is required by the advisory.
While the OIG does not state a specific interval for rechecks, it does require “periodic” checking. The List of Excluded Individuals and Entities (LEIE) is maintained by the OIG, and is updated on a monthly basis, and therefore they recommend reviewing monthly.
However, the Centers for Medicare & Medicaid Services (CMS), as part of their “Medicaid Program Integrity”, requires enrolled Medicaid providers to check the LEIE database and the Excluded Parties List System (EPLS) prior to hiring for their employees and contractors, and “no less frequently than monthly” thereafter. The CMS also requires checking the Social Security Administration’s Death Master File.
That seems like a lot of databases to keep track of; however, you may be able to check all these items under the National Criminal Database with Alias check. The National check includes the OIG and EPLS databases as well as exclusions lists from each state. The check with alias includes a social security number trace within it, which also checks the Social Security Administration’s Death Master File. As a bonus, the National check with Alias will check all names that show up on the social security number trace against the National Database. Check with your vendor for the specific state coverages.
No company wants to pay hefty fines, and yet so many healthcare companies do not check the required lists after hire. Neglecting to complete the required follow-up checks not only leaves your company exposed to potential fines, but also to potential bad hires that can cause harm to your company or to the people who rely on your company for care. Review your company policy and work with your legal team to make any required changes. Then make sure to train all involved on the changes. Safety first is important to everyone, and especially to those in the healthcare industry.
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Sources: cms.gov, exclusions.oig.hhs.gov, Michigan.gov, stateoig.gov