How to Protect Yourself Against Hiring Employees Excluded From Participating in Federal Healthcare ProgramsWednesday, March 7th, 2012
Did you know that if you hire any employee or contract with an entity that has been excluded from participating in a Federal healthcare program, that it could cost you tens of thousands of dollars in fines?
In addition to imposing civil money penalties (CMPs), the Office of Inspector General (OIG) has the authority to exclude any individuals and entities who have engaged in fraud or abuse from participation in Medicare, Medicaid and other Federal healthcare programs. Per the OIG:
- The practical effect of an exclusion is to preclude employment of an excluded individual in any capacity by a health care provider that receives reimbursement, indirectly or directly, from any Federal health care program.
- No Federal payment may be made for any items or services furnished by the excluded individual or entity, even if the payment is being made to another non-excluded provider or supplier.
- In addition, payment may not be made for items and services prescribed by an excluded physician.
Also per the OIG, if you employ an excluded individual while providing services to patients under a Federal healthcare program, you could face:
- A civil money penalty of up to $10,000 for each item or service furnished by the excluded individual or entity and listed on a claim,
- An assessment of up to three times the amount claimed, and
- A possible exclusion from program participation (i.e. Medicare).
For liability to be imposed, current statute requires that the supplier knew or should have known that the employee or entity was excluded. But, it is the OIG’s stance is that suppliers have a duty to check the exclusion status of an employee or contractor before entering into a relationship, or else run the risk of CMP liability.
With fines and revocation of billing privileges at stake, it is not worth the risk to hire someone without performing a check. Additionally, we recommend a retroactive check on existing employees if you have not screened them previously. To protect yourself against entering into a relationship with an excluded individual or entity, take a moment to search the OIG’s Exclusion Database, also known as the List of Excluded Individuals/Entities (LEIE). In addition to potential employees and vendors, be sure to screen each of your current employees for possible exclusions. The database is free, easy to use and is available here: http://exclusions.oig.hhs.gov/.
Below are some tips to keep in mind when searching the OIG’s Exclusion Database:
- You can search for up to 5 names at one time.
- Remember to screen all owners, managers and officers within the company.
- In addition to the employee’s current name, be sure to screen for aliases (i.e. nicknames like Charlie instead of Charles), hyphenated names and maiden names.
- For a broader search, type in the first few letters of the last name, with no first name.
- Don’t rely solely on the address or occupation listed to verify a match. The person may have moved and obtained a different position.
- If you locate someone you believe may be an employee, you can verify if they are the same person by clicking on the name and entering the employee’s social security number.
For more information on OIG exclusions see: