Practice Management Alert

Experts: Exclusions database search must be part of background checks

Slacking off on checking the HHS Office of Inspector General's exclusions list can cost you tens of thousands of dollars -- or even your position at your medical office.
 
Problem: If you hire someone who is on the OIG exclusions list, odds are the feds will find out -- and be none too happy at the discovery. The OIG keeps a database of providers and professionals (coders, billers, receptionists, etc.) who have been excluded from participating in Medicare, Medicaid and other federal healthcare programs.
 
Solution: Get yourself a copy of the exclusions list, and keep it handy so you can check it whenever hiring a new person, says attorney Linda Baumann with Reed Smith in Washington. You should also routinely check the list throughout the year because the OIG updates it frequently.
 
The basics: An -excluded- provider is not permitted to receive any federal healthcare dollars for items or services he furnishes, or prescribes or directs, the OIG makes clear in a Special Advisory Bulletin on the matter.
 
-This payment ban applies to all methods of federal program reimbursement, whether payment results from itemized claims, cost reports, fee schedules or a prospective payment system (PPS),- the OIG says.
 
Danger: If you discover that one of your current employees has been excluded, the OIG says you should terminate the person's employment (or contractual relationship), says attorney John Gilliland II with Gilliland & Caudill in Indianapolis.
 
Good idea: The OIG updates the exclusions list often, so it's a good idea to check the list at least annually, says attorney Robert Wanerman with Epstein Becker & Green in Washington.
 
If you conduct annual compliance training updates, have your employees sign a certification that they received the training. Include in that certification a statement that the employee hasn't been excluded from participation in a federal healthcare program during the past year. -It's not a perfect system, but it shows a good-faith effort to comply,- Wanerman says.
 
Strategy: In addition to your own regular checks, you should have a policy stating that employees must notify you of any charges against them, Gilliland says. Make clear that failure to do so is punishable by termination, Wanerman says. This policy puts the burden on the employee, rather than on you.