OIG Exclusion Checks – An HR Compliance Necessity!

oig exclusion checkAn OIG Exclusion check is one of many employee screening methods to determine whether both potential and existing employees are a compliant choice for an organization. Unfortunately, this can seem like just another meaningless task for an employee who is uninformed and they think it’s ok if they “just don’t have the time”, or, “the HR person is already too busy.”  Responsible for combating health care fraud, the Office of the Inspector General, a department within Health and Humans Services (HHS), maintains a list of individuals or entities (LEIE) that are prohibited from participating in federally funded healthcare programs including Medicare, Medicaid, TRICARE, and VA (sec 1128 exclusion).  State health care programs may also be affected where no payment will be made under a section 1156 exclusion, which also includes Medicare.  

Prescriptions, orders, medical supplies, clinical services, management and administrative job functions provided by an excluded person will not be paid to those individuals, or entities, that have been excluded.  Furthermore, should a practice have the misfortune of employing one of these people heavy fines may be levied and payable, or worse, a lawsuit.  In such a case, ignorance will not be considered an excuse.  Employers are responsible for fully screening their staff, providers, clinicians, all employees, and should also maintain verification or attestations from their contractors that verify their non-excluded status. It is strongly recommended that these screenings occur monthly (at minimum!) and in every fashion of the name, i.e., maiden name.

Two types of exclusions exist, Mandatory and Permissive.  With a minimum of a five-year conviction, the Mandatory Exclusion carries penalties due to fraud, patient abuse and illicit distribution of controlled substances.  Permissive Exclusions may come as a result of state licensure loss to practice, misdemeanor convictions, poor quality care, or even a defaulted student loan.  So, the answer is always, “Take the time to check the OIG Exclusion list (LEIE), both pre-hire and monthly on existing employees, to protect your practice, facility, organization, and yourself from unwanted exposure to risk, fines, or worse.”  After all, isn’t it better to be safe than sorry?  It’s quick, easy and available here:  https://exclusions.oig.hhs.gov/

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