Health care providers who are responsible for billing Medicare and Medicaid have a duty to know if their independent contractors and employees have been excluded from participating in federal health care programs by the Office of the Inspector General.
In the event that a health care provider does employ or contract OIG excluded individuals, Medicare, Medicaid and all other federal health care programs will refuse to pay for any item, prescription or service provided by the excluded individual, and in addition the provider or healthcare facility may receive heavy fines.
How Does Someone End Up on the OIG Exclusion List?
An individual can end up in the OIG exclusion list database for a variety of reasons. Mandatory exclusions include several criminal offenses generally relating to criminal offenses and felonies that relate to health care fraud, theft, or patient abuse or neglect. Individuals may also be excluded for illegally manufacturing, prescribing, distributing or dispensing controlled substances.
Permissive inclusions often range from misdemeanors related to health care fraud or controlled substances, professional incompetence, defaulting on health education loans, unlawful kickback arrangements, and several other factors.
Usually an individual is notified of their status before the exclusion goes through.
How Can an Employer Check for OIG exclusion verification
OIG’s List of Excluded Individuals/Entities (LEIE) provides employers with information on each of the individuals currently excluded from participating in Medicare, Medicaid and Federal health care programs. Companies aren’t required to check the list, but OIG exclusion verification screening is recommended, especially since providers can face penalties for employing OIG excluded individuals.
Different states have different requirements for exclusion screening that also entail monthly checks, so providers should know their state and federal regulations before hiring.