The Office of Inspector General (OIG) is required by law to maintain a list of individuals and entities who have been excluded from federally funded health care programs. This list would include all physicians, medical office staff, and even support staff as potentially being excluded from practicing in the health care industry.
A proper recruiting and hiring process should promote the hiring of individuals with professional integrity, and therefore your employees (hopefully!) would not be part of such a list. However, if your hiring process does not include checking the OIG exclusion list, you should consider the affects it may have on your practice.
Who can be excluded?
The OIG has the authority to exclude individuals and entities from participation in all federally health care programs at their discretion. Their maintained list includes all current excluded individuals, who have been convicted of the following:
- Medicare or Medicaid fraud
- Patient abuse or neglect
- Felony convictions for other health-care related fraud
- Financial misconduct
- Felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances
The OIG could also exclude individuals or entities based on lesser or other offences on their discretion. Examples include, but are not limited to:
- Misdemeanor convictions related to fraud other than Medicare or State health program
- Defaulting on health education loan or scholarship obligations
- Submission of false or fraudulent claims to a federal health care program
- Engaging in unlawful kickback arrangements
What does this mean for your practice?
Proper recruiting and hiring efforts are of the essence. If you have not checked to see if your current employees are on the OIG list, you could have inadvertently hired an individual who has been convicted of a crime. You could also be subject to civil monetary penalties by the OIG if you have hired someone who is on this list.
To protect your practice and avoid these penalties, you need to routinely check the exclusion list to ensure new hires and current employees are not on it. You can do so HERE.
To learn more about the OIG exclusion list, including background information, applying for reinstatement and other tips, visit the OIG site HERE.