The federal Office of Inspector General (OIG) released an Updated Special Advisory Bulletin May 8 on the effects of exclusion from participation in federal health care programs, advised Krieg DeVault LLP.
In general, an exclusion requires no federal health care program payment may be made for any items or services furnished by an excluded individual, or at the medical direction or on the prescription of an excluded person. The May bulletin updates guidance issued in 1999 and reflects changes in the law since that time.
Details on the May bulletin
The bulletin addresses: (1) the scope and effect of exclusion, (2) how exclusions can be violated and applicable sanctions, (3) best practices for screening employees and contractors, and (4) how to use the OIG’s recently updated Provider Self-Disclosure Protocol.
In response to questions, the OIG bulletin gives examples of situations in which the exclusion and payment prohibition apply, including when an excluded person changes professions. For example, if a pharmacist is excluded, then attends medical school and becomes a licensed physician, the individual is still excluded.
The exclusion applies even if the excluded person’s services are not separately billed, but part of a Medicare diagnosis-related group payment (e.g., a nurse’s). It applies to services of excluded individuals indirectly related to patient care, such as preparation of surgical trays. It also applies to administrative and management services and to transportation services, like those of ambulance drivers, paid by a federal health care program.
What you need to do
The bulletin recommends using the List of Excluded Individuals (LEIE) database as “the primary source of information” on excluded individuals. The OIG maintains the LEIE, which offers you the most available information. Find it here.
While no statute or regulation mandates checking the LEIE, it is recommended you do so prior to employing or contracting with an individual. Then, “periodically check” back since the OIG updates the database monthly.
In light of this recent guidance, health care organizations and individuals should review their policies and overall compliance plans to ensure they follow the updated guidance. Civil monetary penalties up to $10,000 apply for each claimed item or service furnished during the period a person was excluded, as well as additional assessments, or civil suits and criminal prosecutions.
Find the May bulletin here. If you have further questions, contact the ISMA Legal Department or Krieg DeVault’s Randall Fearnow at (312) 235-1133.