To ensure the safety of medical products, drugs, devices, and services, businesses in the healthcare industry must have strict controls over their operations. The structure that reviews these operations is the OIG program, which uses exclusion screening software to keep track of the fulfillment of these requirements. Here’s everything you need to know about the OIG exclusion list and how you can ensure not to be in it.
What is the OIG Exclusion List?
For many years, the United States Congress has carefully worked to safeguard the health and welfare of the country’s elderly and impoverished citizens. They’ve done so by enacting laws prohibiting specific people and companies from participating in federally funded health care programs.
The U.S. Office of Inspector General (OIG) implemented a program to exclude persons and companies impacted by different legal authorities and keep track of all parties that are now omitted, known as the List of Excluded Persons and Companies (LEIE).
Healthcare practitioners can ensure they are not hiring or entering into contracts with people or organizations on the LEIE by using exclusion screening software.
If an applicant or employee is found on this list, the hiring organization risks losing Medicare and Medicaid contracts and facing significant financial penalties. Therefore, healthcare employers should avoid hiring excluded employees, contractors, or volunteers.
The Importance of Regularly Checking for Exclusions
Healthcare providers know the HHS OIG Exclusions List, which they consult before employing new staff or entering into contracts with suppliers. However, it is critical to keep examining the database because exclusions from outside the Office of Inspector General or an MFCU might take up to two years to show.
Healthcare providers should develop policies for screening frequency and procedures for positive matches in databases, including the LEIE list. This way, they can mitigate the risk of penalties for non-compliance and document these policies, checks, and self-disclosure reports for record-keeping purposes.
Healthcare providers face significant consequences for engaging with excluded individuals or organizations, including six-figure civil monetary penalties and the risk of being added to the HHS OIG Exclusions List if checks are not performed and interactions continue.
To avoid such severe consequences, healthcare providers must regularly screen individuals and organizations against the OIG Exclusions List.
What is Exclusion Screening?
Exclusion screening ensures that a practice’s vendor, contractor, or current or prospective employee is not prohibited from participating in federal or state healthcare programs like Medicare and Medicaid.
By conducting exclusion screenings, healthcare providers can discover and prevent the involvement of persons or organizations prohibited from participating in government healthcare programs. Ignoring exclusions can have financial consequences, reputational damage, and even legal issues.
Exclusion Screening Software
The OIG maintains a record of people prohibited from participating in government programs. However, states have the power to exclude people for reasons not covered by Federal law, and they may not necessarily report these exclusions to the OIG or other states.
To maintain compliance, companies must search countrywide once a month to see whether their workers are on these exclusion lists.
Using exclusion screening software designed explicitly for this purpose can significantly streamline the process and reduce the effort required for thorough screening. This can help companies comply with regulations and avoid fines or legal issues.
Employers may also use automated exclusion screening software to continuously check and update their exclusion lists, ensuring they are constantly updated with the most recent information. Companies that employ this automated approach can save time and resources while reducing the risk of non-compliance.
Exclusion from Federal Health Care Programs
OIG exclusion from Federal health care programs prohibits payment for items or services provided by an excluded individual or entity or directed by an excluded physician. This exclusion applies to all methods of Federal program reimbursement, including itemized claims, cost reports, fee schedules, and prospective payment systems.
The Federal program prohibits payment for items or services provided by excluded individuals or entities, including administrative and management services not directly related to patient care. It also prohibits payment for an excluded individual’s salary, expenses, or fringe benefits.
The list includes items or services reimbursed by Federal health care programs that violate an OIG exclusion when provided by excluded parties and examples of items or services that may expose their employer or contractor to potential CMP liability.
The Process of Being Excluded
Exclusions are administrative penalties that are only pursued by the OIG. While regulation governs the mechanisms for imposing, appealing, and removing their designation, individuals have relatively limited ability to contest the outcome once the process begins.
For instance, if the OIG seeks to enact an exclusion based on a conviction or licensing action, the defendant cannot challenge the underlying conviction action. The ability to contest the exclusion is limited to its duration.
Reinstatement, or removal from the exclusion list, requires an excluded party to apply and demonstrate no threat to beneficiaries or the program, often involving licensing or restitution-related issues.
Both types of exclusion prohibit an individual or entity from participating in all Federal healthcare programs until their privilege is reinstated.
Compliance with OIG’s Exclusion List
So, how can you avoid the repercussions that come with hiring an excluded individual or entity? The first line of defense for compliance is verifying the LEIE regularly. To minimize possible dangers, providers and health organizations must keep up with the list’s continuous changes.
The HHS OIG specifically recommends checking LEIE before employing or contracting with anyone. This includes verifying the list of current workers and contractors.
The employer is responsible for screening current personnel and implementing an efficient program fully compliant with the OIG.
Conclusion
Employing or dealing with an individual or company on the LEIE can pose substantial risks to an organization and the patients it serves. Searching the LEIE database is an ongoing process that should be monitored and maintained to guarantee compliance.
So, ensure your screening methods are current, and everyone on your team understands how to submit applications. Make full use of exclusion screening software, and you’ll see just how it easy it is to be fully compliant with the OIG requirements.
