OIG Issues Special Advisory Bulletin Regarding Exclusion Sanction Checks on Individuals and Entities
The US Department of Health and Human Services (DHHS), Office of Inspector General (OIG) released a "Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs" on May 8, 2013—the first in over ten years. The OIG originally published a Special Advisory Bulletin in September 1999. What does this mean for your organization's sanction screening practices? The updated 2013 bulletin expands the OIG's exclusion authority.
5 Considerations from the 2013 OIG Exclusion Screening Advisory Bulletin
- Providers should check the OIG List of Excluded Individuals and Entities (LEIE) upon hire and periodically for employees and contractors. It also notes that the OIG updates the LEIE exclusion list monthly "so screening employees and contractors each month best minimizes potential overpayment and Civil and Monetary Fines."
- Providers should review job descriptions, categories of care, and contractual relationships to determine whether an item or service being provided is "directly or indirectly, in whole or in part, payable by a Federal health care program. If the answer is 'yes' the best mechanism for limiting CMP liability is to screen all persons that perform under that contract or that are in that job category."
- No Federal health care program payment can be made for items or services beyond patient care, and includes those for administrative, transportation, filling prescriptions, inputting prescription information, preparation of surgical trays or reviewing treatment plans, regardless of whether such services are separately billed or are included in bundled payment.
- The prohibition for payment applies to administrators such as executives, human resources, information technology, accounting, general counsel and office managers who are on the OIG exclusion list.
- A hospital contracting with a staffing agency is required to ensure that the staffing agency has conducted OIG LEIE exclusion list searches on such staff. Guidance is provided that the hospital can reduce civil and money penalties (CMP's) if it can demonstrate that it reasonably relied on the staffing agency to perform OIG LEIE exclusion list checks on all agency providers regularly and recommends that the provider obtain supporting documentation. The hospital is responsible for civil and money penalties if the hospital does not ensure proper OIG exclusion list checks are performed regularly.
The OIG's latest Advisory Bulletin clearly indicates the need for monthly sanction screening. Depending on the size of your organization, this may become an overwhelming task. With healthcare providers subject to monetary fines, it is highly recommended that all organizations review the 2013 Advisory Bulletin to determine whether compliance programs follow the OIG's best practices. While meeting the monthly requirement can be cumbersome for organizations, online exclusion and sanction screening services such as SanctionCheck by PreCheck can be a viable option to meet this emerging standard.