Employee Exclusions Screenings Must be High Priority

Many healthcare organizations are not aware of how critically important it is to screen their employees against ALL state and federal exclusions databases. The OIG is reviewing organizations in ALL federal healthcare programs - this includes Medicare, Medicaid, CHIP, etc. - for those who have employed individuals on ANY exclusions database. Not only must you screen employees on the OIG Exclusions database, but employers are also responsible to check state exclusions databases as well.

One problematic area that has been encountered is individuals saying that they are not excluded any longer because their 'exclusion' period has passed. This is false information. There is NO AUTOMATIC reinstatement when an individual has been excluded. They must officially apply for reinstatement.

The financial implications of violating this law can be severe. The law states (emphasis added):

An excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a CMP of $10,000 for each item or service furnished during the period that the person or entity was excluded (section 1128A(a)(1)(D) of the Act). The individual or entity may also be subject to treble damages for the amount claimed for each item or service.    -- (42 CFR 1001.3002)

Additional information can be found in the Compliance chapters of the ChiroCode DeskBook and the Behavioral Health DeskBook.

The article "Exclusion Screening Enforcement Actions by OIG are Increasing," available on the Liles Parker website, also includes some helpful resources for larger organizations needing assistance with compliance.

Author: 
Wyn Staheli, Director