Healthcare compliance continues to grow more complex. Your risk grows from a steady flow of new guidelines, oversight, and regulations. This is all because the health care services reimbursed the federal tax dollars. Besides, DOJ (Department of Justice) and DHHS the (Department of Health and Human Services), keep a check how these dollars spent. Therefore, it is the employer’s responsibility to monitor this activity by checking ALL exclusion databases monthly. There are 3 federal databases and 43 State Medicaid databases. These must be searched and cross referenced each month!
Once you are excluded*, however, you are considered to be excluded from all-state lists. According to the Affordable care act, any entity, individual or vendor excluded in a state list is not allowed to participate in the federal Healthcare funds of other states. An entity or person can go through OIG Exclusion by the Medicaid agency.
The consequences of exclusion are assessed by the OIG and can be significant:
$10,000 per item services or claims provided
Statutory treble damages (i.e., three times the amount of the false claim)
Possible exclusion program of the organization
Offers Approximate loss of the right to bill CMS for services
Possible filing of false claims count under the False Claims Act
Probable criminal jail or fines.
IES offers many solutions focused on maintaining the health and wellness of your employees.
We can tailor a program customized to your industry, requirements, and exposures that aligns both with your safety strategy and your policies.
IES removes the responsibility and burden of the monthly exclusion monitoring of all exclusion databases and provides complete reporting, so you can focus on other priorities without the fear of exclusion.
*Exclusions are actions taken against an individual or vendor/entity by the Department of Health and Human Services, Office of Inspector General (OIG).