Keeping the excluded out of government healthcare programs

The Office of Inspector General is using and refining its authority to sanction government contractors that pay individuals and entities excluded from participating in federal healthcare programs.

Brookdale Senior Living Inc., for example, a Tennessee chain of residential communities, agreed to pay the government more than $350,000 to settle allegations of employing two excluded people, the OIG announced.

Exclusions may be mandatory or permissive. Mandatory exclusions follow criminal convictions related to fraud, patient abuse or neglect and substance abuse. Permissive (or discretionary) exclusions may follow submission of fraudulent claims or involvement in kickback schemes.

The OIG is seeking comments on possible updates to its permissive exclusion criteria, according to the global law firm Reed Smith. It's looking for recommendations on differences in criteria for excluding individuals and entities and how or whether to weigh defendants' compliance programs, Reed Smith noted.  

To reduce risks of penalties resulting from paying excluded individuals and entities, many organizations screen applicants against the List of Excluded Individuals and Entities (LEIE) before hiring. But a better practice, according to an e-alert from law firm Reinhart Boerner Van Deuren s.c., is to conduct ongoing screening to see if the status of employees and contractors has changed.

Keep in mind that sanctioned providers, as in the case of Florence Bikundi, may use variations of the name associated with their exclusion to hide it. Therefore, consider these tactics to find evaders:

  1. Enter the person's last name and first initial when searching the LEIE.
  2. Double check names against sources, such as the U.S. General Services Administration System for Award Management.  
  3. Determine if it makes sense to outsource LEIE screening.

Finally, "pick up the phone" if you find a match, the alert recommends. "[Y]ou may have an obligation to disclose to OIG any payments related to any item or service provided by an excluded individual or entity. Failure to disclose may subject you to civil or even criminal liability."

For more:
- read the OIG announcement
- see the e-alert from Reinhart Boerner Van Deuren
- here's the Reed Smith article