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Home Health & Hospice Week

Compliance:

STEER CLEAR OF OIG EXCLUSION LIST PITFALLS

Published on Tue Jan 20, 2009

Ignorance isn't bliss when it comes to excluded employees.

Ending up on the HHS Office of Inspector General's excluded list can be easier than most home care providers think. And if the Centers for Medicare & Medicaid Services or your accrediting body find out you've hired an excluded individual, you could be at risk for more surveys.

If you're not checking potential employees' backgrounds with the OIG, you might be setting your organization up for major problems. Here's what to look for.

The OIG can exclude individuals and entities from participating in federal programs if they have been convicted of certain offenses, sanctioned by other governmental agencies -- or if they participated in "inappropriate activities" related to provision of health care items and services.

Federal health programs include Medicare, Medicaid, Tricare, Veterans Affairs, and all other programs that provide health benefits and are funded directly, in whole or in part, by the U.S. government (except the Federal Employees Health Benefits Program), according to an OIG memo.

The Social Security Act authorizes the OIG to exclude individuals and entities based on particular circumstances. The act specifies when the OIG must exclude and when the OIG may exclude.

The OIG must exclude an individual or entity that has been convicted of:

• Medicare- or Medicaid-related crimes (misdemeanor or felony);

• Patient abuse or neglect (misdemeanor or felony);

• Felony health care fraud (not related to Medicare or Medicaid); or

• Felony controlled substance violations.

The OIG may exclude in several other instances. For example, the OIG may impose exclusions based on:

• Convictions for misdemeanor health care fraud (not related to Medicare or Medicaid);

• Convictions for misdemeanor controlled substance violations;

• Disciplinary actions taken by licensing boards or other federal or state health care programs;

• Quality-of-care issues related to denial of services, excessive/unnecessary services, or substandard care;

• Prohibited activities like false claims, fraud,kickbacks, etc. (with or without a conviction); or

• Defaults on health education assistance loans.

Perform Checks Before Hiring

The compliance reality: Home care providers that hire or contract with individuals or entities on the OIG exclusion list are "absolutely" subject to civil monetary penalties, warns William Mathias,an attorney with Ober/Kaler in Baltimore. In fact, the law firm is seeing more people making voluntary disclosures to the OIG, saying they noticed that they had accidentally employed an excluded individual, for example, he adds.

It pays to self-disclose, Mathias says, "because the sanctions are a lot less severe than if the government discovers [the problem] on its own."

The good news: Home care providers can easily check to see if a person is on the excluded list, says Mathias. Go to the OIG exclusions Web site (http://exclusions.oig.hhs.gov/) and key in the person's name. If it's a common name, like John Smith, you will have the chance to confirm the person's  identity by entering a Social Security number, he adds.

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