Exclusion Checking Requires Ongoing Diligence and Thoroughness
Skilled nursing facilities (SNFs), like all health care providers, are required to check the Office of the Inspector General’s (OIG) Exclusions list to ensure that none of their employees or contractors are excluded from participating in any federal or state health care program. For facilities with many employees, and whose operations involve many staff members, vendors, and contractors, this can be a time-consuming task. However, faced with the costly consequences of employing an excluded individual or doing business with an excluded provider/contractor, the time involved conducting a thorough check is justified. Consider the following example:
On November 15, 2016, a skilled nursing facility in New York City entered into a $110,223.36 settlement agreement with OIG. The settlement agreement resolves allegations that the facility employed two individuals who were excluded from participating in Federal health care programs. OIG’s investigation revealed that one excluded individual was a registered nurse supervisor and the other was a licensed practical nurse. While excluded, both individuals provided items or services to patients that were billed to Federal health care programs.
The OIG is not the only entity with the power to levy a fine if a facility fails to comply with exclusion check requirements. The Social Security Administration is also empowered to fine any business involved in fraudulent activities or that employs a person the OIG has excluded and placed on their listings.
It should be noted that relying on an outside organization to perform exclusion screening for a facility does not absolve providers from liability for overpayment or civil monetary penalties (CMP) related to hiring excluded employees or vendors. So, the “due diligence” that should be applied when others perform exclusion screening for the entity is to request and maintain documentation that demonstrates the status of each person checked against the exclusion list. Contracts with vendors and contractors should require exclusion screening as part of the agreement.
With such risk involved, how often should exclusion screening be done? There are no specific legal requirements for this. Some providers recheck annually, some recheck quarterly, and others recheck monthly. Although new and existing employees are required to reveal to an employer if they have been excluded, that does not always occur. Potential new employees should be screened for exclusion prior to being hired. Health care providers must be aware of any sanctioned individuals or entities under contract. Checking for sanctions is essential because 40% of all exclusions start with a sanction. Also, it should be noted that if a provider is excluded in one state, the exclusion is extended to all states.
Exclusion checking can be somewhat daunting, because as of February 2015, there were 35 exclusion lists and more than 1,600 sanction lists. In addition to the OIG exclusion list, states have exclusion data bases that need to be checked. Don’t let that awareness keep you from moving ahead. A good place to start is here: http://exclusions.oig.hhs.gov/. It only takes a few seconds to enter a name and print a report, and the future protection afforded is worth it.
