Breaking Compliance News Blog

Long Term Care Organization Pays Excluded Provider Penalty

Posted by Margaret Scavotto, JD, CHC on 7/24/14 5:18 PM

Find me on:

The Office of Inspector General (OIG) announced that a faith-based, not-for-profit long term care health and rehabilitation center entered a $30,122 settlement with the government. The center employed a nurse who was excluded from participating in Federal health care programs such as Medicare and Medicaid.

Are any of your employees excluded providers?

If you aren’t conducting monthly excluded provider screens, it’s possible that you are inadvertently employing an excluded provider—and earning penalties on a daily basis.

Individuals and contractors can become excluded providers for a variety of reasons, including Medicare or Medicaid fraud; patient abuse or neglect; health care related felonies; controlled substance felonies; some misdemeanors; suspension or revocation of a health care license; provisions of unnecessary services; submission of false claims; and kickbacks.

Medicare and Medicaid will not pay for services provided by excluded providers. Any Federal health care program payments made to a provider for services rendered by an excluded provider are to be multiplied by three and returned. In addition, providers can be assessed a Civil Monetary Penalty of up to $10,000 per claim, and risk joining the list of excluded providers themselves.

Screen monthly to minimize the risk of penalties

The OIG recommends that employees and contractors be screened pre-hire and re-screened monthly. If your state Medicaid program maintains an excluded provider list, that should be checked too.  

There are software solutions that can help providers stay abreast of changes to exclusion lists and complete regular screening. Partnering with a software vendor is a relatively simple and cost effective alternative to using staff time to perform the same function. Whether you screen manually or by using a software service, make routine employee screens part of your compliance program.

If you conduct a screen and find an excluded employee or contractor, contact legal counsel immediately. Self-disclosure and quick action can result in reduced OIG penalties and repayment amounts.

Learn more

Because excluded provider screening is not required by law, can I skip it?

The government won’t pay for services provided by excluded providers. What types of services does this cover?

compliance risk assessment annual review

Topics: Penalties and Enforcement, Excluded Providers

    Privacy Policy           Terms of Use