Healthcare exclusions – Another compliance challenge that can cost you hundreds of thousands per occurrence.
It’s another requirement to confuse the HR and Compliance teams in a healthcare organization, but not staying current with this ever-changing list will cost dearly.
Healthcare exclusions. What exactly are they?
The OIG, Office of Inspector General, maintains a list of individuals and entities that they’ve excluded from working at or with your company based on their behavior history, and it is referred to as LEIE.
There are various reasons that an individual or entity gets excluded from working in healthcare, including program-related crimes, patient abuse or neglect, felony health care fraud, felony convictions related to a controlled substance, failing to repay student loans, among others. This means that if any of your staff, even your receptionist, or any of your vendors, get onto the exclusion list, you run the risk of nonpayment for services and fines. These fines range from several thousand to hundreds of thousands of dollars.
To get an idea of current and historical fines, see the links at the end of this article. The calculation of the fines is complex, wide-ranging, and factors like proactive self-reporting rather than discovery through an OIG investigation can make a huge difference.
What’s so hard about checking a list?
The challenge is that this list is updated continuously, typically every month, and to make matters worse, it’s not just one list. Currently, there are at least 41 lists that exist across both federal and state levels. How are we supposed to monitor all of these lists to ensure we stay in compliance and avoid penalties?
In a perfect world, an excluded individual or entity would inform you as such. But the world isn’t perfect.
Some organizations choose to search the list in-house, but which list or lists are they searching for? No federal or state list is complete or current at any point in time. Are there other sources they should be checking?!
The first thing to do is to clearly understand what you are getting in your current background screening process and how knowledgeable your service provider is on this requirement. Once you understand your current exposure, you can reconsider your risk tolerance and determine the lengths to which you want to go. Regardless, the best penalty avoidance is to implement a proactive strategy to find potential matches of your candidates and employee pool. By educating yourself with the nuances, you will increase your compliance with healthcare exclusions.
To ensure HR confidence in healthcare exclusions and background checks, have a conversation with your screening provider and share pertinent information with them so they can help you out. Information, such as the States you operate in, types of positions, recruiting process, and others, can help a screening provider provide suggestions for preferred application and background check methods.
This information is provided as a courtesy, may change, and is not intended as legal guidance.
Below are links to current and historical OIG fines for excluded individuals. Click on any of these links, and search for Employing an excluded individual’:
Provider Self-Disclosure Settlements
Civil Monetary Penalties and Affirmative Exclusions
CIA Reportable Event Settlements