Be Careful Who You Hire

The Office of the Inspector General (OIG) urges health care providers and entities to check the OIG List of Excluded Individuals/Entities on the OIG website prior to hiring or contracting with individuals or entities.  They also advise health care providers to periodically check the web site to determine the participation/exclusion status of current employees and contractors.

 In 1977, in the Medicare-Medicaid Anti-Fraud and Abuse Amendment, Congress first mandated the exclusion of physicians and other practitioners convicted of program-related crimes from participation in Medicare and Medicaid.  In 1981,Congress enacted the Civil Monetary Penalties(CMPs) law  which authorizes the Health & Human Services Department (HHS) and the OIG to impose CMPs, assessments and program exclusions against individuals and entities who submit false or fraudulent, or otherwise improper claims for Medicare or Medicaid payment during a period of program exclusion. 

The enactment of HIPAA (1996) and the Balanced Budget Act (1997) extended the exclusions to all Federal health care programs and included health care providers or entities that employ or contract with excluded individuals for the provision of services or items to Federal program beneficiaries.  This includes but is not limited to nurses, technicians or other individuals who work for a medical practice where their services are related to administrative duties, preparation of surgical trays or review of treatment plans if such services are reimbursed directly or indirectly by a Federal health care program.

Billing companies, under their compliance programs, must also screen their employees as they submit claims to federal health care programs.  In addition to performing a criminal background check, AHS screens all new hires against the OIG List of Excluded Individuals/Entities and screens all active employees twice a year.

For more information on other employees/contractors subject to exclusion, click below.  

OIG Exclusion Program  (Opens in a new window)

Tags: Fraud and Abuse