A home health company in Connecticut and its owner entered into a civil settlement agreement with the federal government to resolve allegations of improperly employing an individual who was excluded from all federal healthcare programs. The home health company will pay $28,246 to resolve their liability for hiring and employing a physical therapist while he was excluded from all federal healthcare programs.
In 2012, a physical therapist pleaded guilty to one count of obstructing a federal audit and, pursuant to a related civil settlement, agreed to pay $328,828. In addition, the physical therapist entered into a six-year Integrity Agreement with the U.S. Department of Health and Human Services designed to ensure future compliance with the requirements of the Medicare program. The physical therapist later defaulted on his obligations under the Integrity Agreement and was excluded from all federal healthcare programs in 2015.
In November 2018, the home health company hired the physical therapist into a management position. The physical therapist served in that position until March 2019.
When the U.S. Department of Health and Human Services Office of Inspector General (OIG) excludes an individual or an entity from federal healthcare programs, no program payments may be made for items or services furnished by that excluded individual or entity.
In September 1999, OIG issued a Special Advisory Bulletin to provide guidance to healthcare providers who might employ or contract with an excluded individual or entity. In May 2013, OIG issued an Updated Special Advisory Bulletin containing additional guidance. Both the original and updated Special Advisory Bulletins advised that, in order to avoid potential liability, healthcare providers should check the List of Excluded Individuals and Entities (LEIE) on the OIG web site (http://oig.hhs.gov/exclusions).
Anyone who suspects healthcare fraud is encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 777-6311.
Issue:
All employers who receive federal and state funds for providing healthcare services must check the List of Excluded Individuals and Entities (LEIE) on the OIG website for all potential employees and vendors/contractors. An individual who is placed on the LEIE should not be hired. Hiring a person who appears on the LEIE can result in the facility not being paid by federal or state programs for the services provided that were rendered by the excluded person while he or she was an employee. It is highly recommended that a designated person within the facility checks the LEIE monthly to ensure that no current employees or vendors/contractors have been added to the Exclusion List since checks were conducted initially.
Discussion Points:
- Review your policies and procedures for screening of potential employees to confirm that they are not included on the OIG Exclusion List. In addition, review your policy and procedure for frequency of checking the OIG Exclusion List for all current employees and vendors. Update policies as necessary.
- Train all appropriate staff on the requirement for checking the OIG LEIE link for all new potential hires, current employees, and vendors, and the frequency for repeating the checks. Document that the trainings occurred and file the signed document in each employee’s education file.
- Periodically audit to ensure that all new employees have been confirmed as not being on the OIG LEIE. Also, determine that routine checks are being conducted for current employees to ensure that they have not been added to the OIG Exclusion List.
