Part B Insider (Multispecialty) Coding Alert

Published on Thu Oct 25, 2012 PDF

You should have lots of good reasons for taking the time to check your staff against the OIG's exclusion list -- maybe more than 80,000 of them.

After it self-disclosed conduct to the OIG, a home health agency in Wichita, Kan., agreed to pay $81,102 for allegedly violating the Civil Monetary Penalties Law, the OIG says in a new post to its website. The OIG alleges that the company employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

The OIG doesn't disclose whether the excluded employee was involved in direct patient care.

The company in question is likely far from alone. In a new study, the OIG randomly chose 500 providers from the population of those enrolled in the 12 managed care entities contracted with state Medicaid programs. "Most providers reported using a variety of safeguards to ensure they do not employ excluded individuals, but identified costs and resource burdens as challenges in executing those safeguards," the OIG found. But about 7 percent of providers didn't check the exclusions status of their employees, according to the OIG investigation.

Of the 248,869 individuals listed on employee rosters the OIG collected from 14 sampled providers, the watchdog agency identified 16 individuals who were excluded. "Incorrect names and failure of contractors to follow procedures contributed to the employment of the excluded individuals," found the report, which is available at https://oig.hhs.gov/oei/reports/oei-07-09-00632.pdf.