OIG Screening Made Easy: Understanding OIG Exclusion and the Exclusions List OIG

  

The healthcare industry has many regulations that require compliance from both the healthcare provider as well as those providing services associated

with the provision of healthcare. These regulations require compliance with Federal Privacy Laws as well as accurate billing by submitting the proper code. While the above-mentioned examples represent a significant amount of information, when working in healthcare, the one most important item that needs to be addressed is the exclusions screening process.

 

Exclusion Screening sounds like complicated legalese, but really it just means you want to ensure that the people that you hire are qualified to work with any federal healthcare programs. Let’s break down what OIG Exclusion is, and why OIG screening is important, and how to use the Exclusion List OIG to protect your company.

The Office of Inspector General (OIG), the HHS’ “health police”, investigates and enforces violations of state and federal law in accordance with their mission to prevent and reduce fraud, waste, and abuse in primary care and pediatric programs (such as Medicare and Medicaid).

The OIG imposes penalties for violations of the law. Specifically, the OIG has the authority to “exclude” individuals and entities (such as providers) from participation in federally-funded health care programs. This is commonly referred to as an OIG exclusion.

If an individual is placed on the OIG exclusion list, he or she is prohibited from participating in any form of federally-funded health care program. This prohibition extends beyond physicians; it also applies to nurses, allied health staff, credentialing organizations, outside vendors, and/or independent laboratories and billing companies.

There are many reasons as to why a person or entity could be placed on an OIG exclusion list, including:

• Breaching the MediCare or MediCaid program.

• Abuse or neglect of a patient.

• A felony conviction associated with the provision of healthcare services.

• Defaulting on a federal student loan for health-related education expenses.

Why is OIG Screening Important?

Many people think that their staff are trustworthy and therefore feel OIG screening isn't necessary. The truth is that OIG screening is not only needed for many reasons (including protecting the organization from possible financial impact), but it's also legally required! If a practice hires someone who has been excluded by the OIG and they provide services for federal reimbursement (directly or indirectly), the practice may face substantial fines - up to several thousand dollars for each claim submitted - and may also have to refund the entire amount reimbursed by the federal government to the organization for the period during which the employee was employed.

However, the monetary consequences aren't the only reason to perform OIG screenings; screening regularly also protects the patients of your organization from being treated by individuals with known issues related to prior behavior or incompetency.

OIG Exclusions Check Process

How do you know if someone has been banned? You need to look at The Exclusions List, OIG Exclusions List (The List of Excluded Individuals/Entities - LEIE).

The process is generally as follows:

Go on the Database: The OIG maintains an online public database.

Search for Names: You will enter the names of your employees/vendors.

Verify An Association: If a name comes up, you will then verify with a Social Security Number (SSN) or Employer Identification Number (EIN) to verify if you have the appropriate match. You do not want to accidentally terminate a "John Smith" due to another different "John Smith" being excluded.

The following best practices for exclusion screening should support your overall compliance efforts:

To ensure ongoing compliance, you can not simply check the list at the time of hire for individuals. The Exclusions List OIG is updated each month, so an individual who was previously cleared in January may have been subsequently excluded in February.

Follow these three best practices to have the greatest likelihood of success:

Monthly Checks: OIG recommends you screen your entire workforce against the most current version of the Exclusions List at least once every month.

Check All Employees: Do not limit your screening to physicians only, all employees whose compensation is paid from federal funds should be screened.

Retain Documentation: Keep documentation of your screening results to utilize as proof if you are ever audited and to demonstrate you exercised due diligence.

Conclusion

It’s not difficult to manage your compliance responsibilities. The first thing you need to understand regarding compliance is that, by learning the fundamentals of OIG Exclusions and doing regular exclusions screenings according to a set schedule, you can greatly improve your financial well-being as well as your patients’ health. A simple task (exclusion screening) has a huge impact on how you operate a successful and trustworthy healthcare organisation.