Health Care Industry Requirements. OIG/GSA explained!
The HHS Office of Inspector General (OIG) issued an Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs on May 8, 2013. These guidelines recommend that health care providers screen their employees and contractors monthly to confirm that they are not on the OIG’s List of Excluded Individuals/Entities (EXCLUSION LIST).
In the past few years, we have seen an influx of complex regulations and increased litigation in the industry, making it even more difficult for companies to adhere to compliance best practices. Inadequate due diligence and negligent hiring practices in the healthcare sector harms not only an organization, but its patients, as well. More often than not, poor hiring decisions are a contributing factor in the rise of lawsuits, medical malpractice claims, and subsequent multimillion dollar settlements.
The big questions?
- Is your business in the health care industry?
- Do you participate in any Federal health care programs?
- Do you receive any Federal funding?
- Are you aware of the screening requirements?
Your questions answered!
What are the OIG/GSA exclusion lists?
Providers who receive payment from the government for Medicare, Medicaid and other federally funded health care programs are required to screen employees and contractors against the U.S. Department of Health & Human Services Office of the Inspector General (OIG) exclusion list to ensure they have not been excluded from a federal health care program. Providers that employ sanctioned individuals may be forced to return all federal funds received from these programs going back to the date the person became employed.
Who Should Providers Screen for Exclusion?
Providers should screen employees and contractors to ensure they have not been excluded from a Federal health care program. In addition, the Affordable Care Act of 2010 extends civil money penalties (CMP) liability to providers that provide other items or services prescribed or ordered by an excluded person. As a result, providers should screen physicians and other practitioners who order items and services that the provider renders. This also includes contractors, vendors and all third party providers.
How Often Should Exclusion Checks Be Done?
While there is no statutory or regulatory requirement to check the Exclusion List, OIG recommends that providers screen their employees and contractors for exclusion prior to employment or engagement. In addition, providers should conduct exclusion checks on a regular basis for existing employees and contractors.
What Happens When the Check Reveals that an Employee or Contractor Has Been Excluded?
Obviously, the provider should not employ an individual or enter into a contract if the provider's screening shows that the prospective employee or contractor has been excluded.
What do the different exclusion types mean?
Each individual or entity on the exclusion falls into a different category as a result of why they were excluded. For example, the most common exclusion type relates to exclusions due to "License evocation/suspension/surrender". More information on the varying exclusion types can be found on the OIG website.
Health Care Compliance in One Report with OPENonline
OPENonline’s Federal OIG/GSA Search identifies any individuals or entities that have committed fraud against Medicare, Medicaid, or any other Federally funded health care program. This product has the ability to run large groups of employees at one time and provide one concise, detailed, easy-to-read report at minimal cost. The Federal OIG/GSA Search is comprised of OIG (Office of Inspector General), GSA (General Services Administration), FDA (Food and Drug Administration), DEA (Drug Enforcement Agency) and action taken by licensing boards in all 50 states.
- Results instantly available in one concise, easy-to-read report
- Batch uploads to run large group of employees at one time
- Information directly from OIG’s List of Excluded Individuals/Entities (LEIE) ad GSA’s Excluded Parties List System (EPLS)
Regulations and increased litigation in the healthcare industry emphasize the need for a thorough background check. Organizations within the healthcare industry can count on OPENonline to protect their reputation and ensure the safety of staff and patients by uncovering high-risk or sanctioned individuals early in the employment background screening process. SelectCare is OPENonline's healthcare background screening solution. SelectCare is simply a suite of services that OPENonline offers to conduct a thorough employment background check for the healthcare industry.
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This is not legal advice. For legal advice, please seek legal counsel.
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