Medicare Compliance & Reimbursement

Failure to cross-check OIG exclusion list can hit you where it hurts the most -- in your pocket.

Two home care providers are ruing not having looked up the background of their employees before hire. Unfortunately these employees turned out to be on the OIG's. See how you can avoid making the same mistake.

Paying the government tens of thousands of dollars is the hard penalty these home care providers had to face this summer, according to information newly posted to the OIG's website. Cooperative Home Care in Missouri agreed to pay $121,010 for employing an individual that it knew or should have known was excluded from participation in Federal health care programs, the OIG says. And after it self-disclosed conduct to the OIG, Seasons Hospice and Palliative Care of Southern Florida Inc. in Florida, agreed to pay $73,428 for the same violation.

Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties, the OIG warns on its website. Checking the OIG's List of Excluded Individuals and Entities (LEIE) is key to avoiding these violations, stresses attorney John Gilliland with The Gilliland Law Firm in Indianapolis.

The best way to find excluded individuals is the OIG's exclusion list, advises attorney Kendra Conover with Hall, Render, Killian, Heath & Lyman in Indianapolis.

Use The 5 Ws To Cover Your Excluded Employee Bases:

Who? Run all new hires through a check, Gilliland counsels. Also, check a random selection of current employees. If you can swing it based on your size, check all current employees and contractors at specified time points, Conover recommends.

What? Use the OIG's database at http://oig.hhs.gov/exclusions/index.asp to run the check.

Check previous names as well as the employee's current name, Gilliland says. If a name match is made, the database can verify the match using a Social Security Number or Employer Identification Number, the OIG says. Keep a record of your reviews, Conover suggests.

When? Check all new hires at the time of hire, Gilliland offers. Run your checks on other employees and contractors monthly, the attorneys say.

Where? At the OIG's website, you can download the exclusions database and monthly supplements to your own computer. Or you can run an online search for up to five names at a time.

Why? You run major financial and compliance risks by skipping an exclusions database check. And don't assume you're in the clear once an individual's exclusion period is over.

Reinstatement of excluded entities and individuals is not automatic once the period of exclusion ends, the OIG explains. Those wishing to again participate in the Medicare, Medicaid, and any Federal health care program must apply for reinstatement and receive notice from OIG that reinstatement has been granted.