Healthcare compliance continues to grow more complex. Your risk grows from a steady flow of new guidelines, oversight, and regulations. One driver for this are health care services reimbursed by the federal tax dollars. The DOJ (Department of Justice) and DHHS (Department of Health and Human Services), have oversight on how these dollars spent and focus on the enforcement of health care fraud, waste, and abuse.
An Office of Inspector General (OIG) exclusion is an administrative action taken against an individual or entity (such as a provider or vendor) by the Dept. of Health and Human Services (HHS), Office of Inspector General (OIG). The HHS OIG is in charge of enforcing exclusions against individuals or entities. Should a person or entity be excluded, they are prohibited from participating in reimbursements for or from federally funded healthcare programs (CMS.gov – Centers for Medicare & Medicaid Services).
The exclusion* is effective in all US states – not just the state where the person or entity receives the exclusion notice. 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. Can your organization afford to monitor 3 federal databases AND 43 state databases? Can you afford not to?
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
*Exclusions are actions taken against an individual or vendor/entity by the Department of Health and Human Services, Office of Inspector General (OIG).
Monitoring OIG Exclusion Lists
It is the employer’s responsibility to monitor this activity by checking ALL exclusion databases monthly. RememberThe OIG mandates that healthcare organizations do not hire or do business with “excluded or sanctioned” individuals or entities, so employees AND vendors must be searched every month if an organization is to remain fully compliant! That is a lot of work, and risk.
Our real-time Exclusion monitoring service removes the responsibility and burden of monthly monitoring of all exclusion databases and provides complete reporting, so you can focus on other priorities without the fear of the potential penalties of doing business with excluded person or entity.