Jeannine LeCompte, Compliance Research Specialist
Employee verification in the long-term care facility environment forms a vital aspect of adhering to the legally-mandated requirements of a compliance and ethics program.
The Office of Inspector General (OIG) is required to exclude from participation in all federal healthcare programs any individuals and entities convicted of Medicare or Medicaid fraud; patient abuse, neglect, or exploitation; felony convictions for other healthcare-related fraud, theft, or financial misconduct; or felonies for unlawful manufacture, distribution, prescription, or dispensing of controlled substances.
In terms of the Balanced Budget Act of 1997, the OIG is also authorized to impose civil money penalties against providers that employ or contract with “excluded persons” who provide items or services for which payment may be made by federal healthcare programs, such as Medicare or Medicaid.
To prevent a violation, facilities must screen every employee, contractor, and vendor against the OIG List of Excluded Individuals and Entities, which is available online at https://exclusions.oig.hhs.gov. In addition, all contractors and vendors must be screened against the OIG list of debarred contractors, which is available at https://www.sam.gov/SAM/.
Facilities should also develop compliance protocols which will lead to the periodic recheck of all employees, contractors, and vendors, for the obvious reason that their status may change. OIG databases are updated monthly, so it is considered best practice to conduct monthly checks.
The OIG recommends adding a question to job applications, asking if the applicant is an OIG-excluded individual. This will aid later corrective action if the employee has made a false declaration.
If a current employee, contractor, or vendor is discovered to be on the excluded list or the debarred list, employment or any existing contract must be immediately terminated, and a report made to the OIG.
Employees should also be reminded of their legal duties in this regard. They are under an obligation to notify their employer as soon as possible if they become excluded during their time of employment, and to immediately report if they have knowledge that a co-worker, contractor, or vendor has been added to the exclusion list.
