Do you check to see if your employees are on exclusion lists?
Under the Social Security Act the Office of the Inspector General (OIG) has the authority to exclude individuals and entities from Federally funded healthcare programs (oig.hhs.gov).
The OIG excludes individuals and entities under two categories, mandatory and permissive.
Mandatory exclusions are those that the OIG, by law, is required to exclude. These include being convicted in the following criminal offenses:
Offenses related to the deliver of items or services under Medicare, Medicaid, SCHIP, or State health care programs
Patient abuse or neglect
Health care related felony of fraud, theft, or other financial misconduct
Felony conviction related to manufacture, distribution, prescription, or dispensing of controlled substances.
Permissive exclusions are those where the OIG retains the right to exclude, include (but not limited to):
Misdemeanor health care fraud other than Medicare or State program
Fraud in a Federal, State or local government run program, other than health care
Misdemeanor conviction related to manufacture, distribution, prescription, or dispensing of controlled substances.
Suspension of healthcare license
Submission of false or fraudulent claims
Engaging in kickback arrangements
Violations by excluded individuals and entities could incur a penalty of $10,000 per item or service, assessment of up to 3x amount claimed per item or service, deny reinstatement to Federal program, and criminal and civil actions.
Every practice should have a policy and plan in place for regularly checking the LEIE for every employee. By performing this on a regular basis, preferably once a month, you ensure that you will not incur any of the fines or penalties associated with submitting claims for any one on the LEIE. This also ensures that you will not lose out on reimbursement for services performed.