Does using a laboratory service provider excluded by the Office of Inspector General from participating in all Federal healthcare programs to provide services cause a facility’s submission of claims for reimbursement to Medicare and Medicaid to be unlawful?
Compliance Perspective – OIG Exclusion
Policies and Procedures: The Compliance and Ethics Officer with the Administrator will examine the facility’s policies and procedures regarding the identification of excluded persons and entities from Federal Healthcare programs. Education and Training: Administrative staff will receive education and training on the protocols for screening and identifying OIG excluded persons and entities. Auditing: An audit will be conducted to verify that no entity or individual currently providing healthcare services or products to the facility has been excluded from Federal or State healthcare programs. The results of the audit will be summarized and provided to the Compliance Committee. Periodically, a review is needed to ensure that policies and procedures, education and training are current.
Recently, an Administrative Law Judge (ALJ) upheld the Office of Inspector General’s 15-year exclusion of Karim Maghareh, Ph.D. and BestCare Laboratory Services, LLC, from participation in all Federal Healthcare programs under section 1128(b)(7) of the Social Security Act. Under that section of the Social Security Act, the OIG may exclude persons from the Federal health care programs for presenting or causing to be presented claims for items or services that the person knows or should know were not provided as claimed or are otherwise false or fraudulent.
Maghareh is the majority owner and CEO of BestCare, a clinical laboratory with its primary facility in Webster, Texas. Based on evidence presented at an administrative hearing, the ALJ found that Maghareh and BestCare submitted false claims to Medicare for reimbursement of travel costs associated with the collection of samples on which BestCare performed laboratory tests. Specifically, BestCare billed Medicare for trained personnel travel, but instead used commercial airline flights to ship samples that were unaccompanied by trained personnel.
The ALJ stated that BestCare and Maghareh’s “billing scheme involved sending samples by air hundreds of miles for no discernible reason aside from maximizing billing revenue solely for their benefit. They clearly should not be trusted to access program funds.”
The OIG’s exclusion authority protects the integrity of the Federal health care programs from persons who present a risk to those programs.
