Employers Need To Heed The Exclusion List
Judi Kulus, RN
As evidenced by an uptick in reported civil money penalty (CMP) settlements, ranging from $10,000 to $353,248.82, the Office of Inspector General (OIG) is holding nursing home providers’ feet to the fire for employing individuals excluded from federal health programs, including Medicare and Medicaid.
By July of this year, reported settlements for alleged incidents of employment of excluded individuals—who were listed as nurses in a number of the cases—topped the numbers reported all of last year. In July alone, there were three cases of alleged false and fraudulent claims, primarily involving the employment of individuals that facility staff knew or should have known were excluded from participation in federal health care programs.
What Does Excluded Mean?
An excluded individual is someone whom OIG has deemed disbarred or otherwise ineligible from participation in all federal health care programs. Activities that exclude an individual or entity from participation include criminal offenses, such as Medicare or Medicaid fraud; patient abuse or neglect; and felony convictions for health care–related fraud, theft, or other financial misconduct, as well as the unlawful manufacturing, distributing, prescribing, or dispensing of controlled substances. Federal law prohibits skilled nursing facilities that participate in federal health care programs from receiving payment for services provided by disbarred people. These services include both patient care and non-resident services such as administrative, clerical, and other types. When facility staff either self-report or are found to have billed for services during the time that a disbarred individual provided services, CMPs are likely to be assessed against the facility. While the mandate to monitor the OIG exclusion list has been around for a long time, nursing home staff can easily skip this important step in the hiring process. OIG has sought to make compliance as simple as possible by posting a searchable list of excluded entities and individuals at https://exclusions.oig.hhs.gov/
The requirement is to check individuals being considered for employment, but staff should be aware that it also includes contractors and vendors.