What Is An OIG Screening

What Is An OIG Screening?

OIG screening is a process to verify whether or not a potential or current employee is on the OIG Exclusion List and not allowed to participate in any way with a Federal healthcare program or its health services. There are no warnings or notifications issued by OIG that tell of who is excluded on the List of Excluded Individuals/Entities or the LEIE. So a screening, better known as an exclusion screening, is something that needs to be done regularly to see what exclusions exist on the LEIE.

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Inspector General Exclusion

The OIG list is compiled by the Office of Inspector General. It includes all entities or individuals who are not allowed to participate in any healthcare program funded by the Federal government. This includes Medicare and Medicaid programs as well as other Federal funded health care programs. The list is called the List of Excluded Individuals/Entities. It is necessary for any provider to search the database for all the data maintained by the OIG, SAM.gov and any state Exclusion database and do a screening. Each employee, contractor, subcontractor or new hire needs to have an exclusion screening in this way, so that if they are on the Exclusion List, they are not hired or continued in employment.

Providers put the name of the employee and his birth date into the database. Anyone with a similar name will show, and the provider needs to verify whether it is his employee or not. All variations of names need to be checked, including maiden names, as well as name diminutives (such as Jimmy instead of James). The results gotten can be cross-checked with the employee’s social security number and birth date. Since providers want to be in compliance in not hiring excluded people, it is wise to screen every potential hire and employee.

How Often Should You Screen?

The screening checks of those to be hired in health care should be done every month, as names get removed when appealed or in other circumstances. If it is impossible to do a screening monthly, it should be done as often as possible. OIG updates the list monthly. Another option is to hire a vendor to do the search and the screening via an assigned compliance program. It is definitely a labor-intensive action, particularly for large companies. There are particular people that should be screened. The employer should be aware of these. The providers should do a screening of the LEIE on the following:

  • Employees (no matter what level of employee)
  • Contractors
  • Vendors
  • Medical staff
  • Volunteers
  • Referring physicians and practitioners
  • Board members
  • Anyone else working closely with the provider

There are severe consequences if someone excluded works with or for a healthcare program that is federally funded. There can be fines for up to $10,000 for each service that the excluded party has provided. Providers can also face criminal consequences which can include being denied reinstatement to any healthcare programs and health services that are federally funded. A provider who does a screening on employees and subcontractors every month will minimize liability and criminal charges.

How often do you have to check the exclusion list?

So, how often do you have to check the OIG exclusion list? The OIG recommends doing a screen of the Exclusion List on a regular basis so entities do not in error hire those on the list. The list is constantly evolving with people added and removed continually, even daily, so exclusions are constantly changing. The OIG’s Exclusion List is a list of individuals and entities who are not allowed to work for or with any healthcare program of the government such as Medicare or Medicaid and other gov health services. They are excluded for various reasons some of which are:

  • Fraud
  • Patient abuse
  • Patient neglect
  • Program related convictions
  • License revocation

Individual Exclusions from the OIG Organization Search

By excluding those from any Federal health care programs it means that the exclusion is from Medicare, Medicaid, healthcare programs funded by the United States either directly or indirectly, and any entity that provides healthcare benefits funded by the United States. An employer should check the OIG list whenever hiring or contracting someone, such as vendors or subcontractors to see if any one of them is on the exclusions list. Then they should check each one of the employees or subcontractors against the OIG’s list every month thereafter. There are thirty-seven states which have state-based exclusion lists which also should be checked. There are resources where you can search out state exclusion lists.

Is There a Way to Remove Health Care Individuals from the List?

Depending on the exclusion and the circumstance of it, some may have the ability to get reinstated and no longer be excluded. That person or entity would no longer be on the LEIE (List of Excluded Individuals/Entities). Any exclusions would be discovered by an employer when checking the list. A provider isn’t allowed to give payment to anyone on the LEIE. The way a person can be reinstated is by going through an appeals process. The first appeal would be to the HHS Administrative Law Judge. From him the individual gets a decision that is based on the information he or she provides which shows why the exclusion is not warranted, including information regarding their background in the healthcare industry if any. If the person does not get a positive response, he can go further with the appeal and turn to the HHS Departmental Appeals Board. When no positive outcome there, it can be taken even further and the person can request a judicial review with the Federal Court. Following the exact requisites for these appeals can get an individual or entity removed from the exclusion list.

For those who intend to appeal and get reinstated, it is wise to contact an experienced attorney to help with the appeals. He knows what sort of information needs to be presented and how to present it as well as expert guidance needed. Hiring an attorney can mean the difference between being on the list and having your entire career affected, and not being on the list so you can move forward on the path you’ve chosen. An attorney will effectively care for your concerns and help you appeal.

What does it mean to be on the OIG list?

So, what does it mean to be on the OIG exclusion list? It’s important to know what the OIG list is as well as what it means to be on it. The Office of Inspector General keeps a list of all individuals or entities that are excluded from participating in health care such as Medicaid, Medicare, and other Federal healthcare programs and services. This list is called the LEIE or List of Excluded Individuals/Entities. The public, patients and everyone in the healthcare industry can thereby stay informed.

The OIG takes into consideration sections of the Social Security Act in order to determine whether or not they will exclude someone from the Federal programs. Those are important sources of data for the OIG. When they decide to exclude an individual or entity, they will send them a Notice of Intent to Exclude. This doesn’t mean they are excluded. The person who is receiving the notice can provide materials which the OIG will carefully consider before moving forward. The person who is receiving this notice has 30 days to gather the information to explain why the exclusion is not warranted.

Excluded from Medicare Sanctions List by OIG

When you are going to be placed on the LEIE, the OIG will send a Notice of Exclusion with an explanation of the details of the exclusion, as well as your appeal rights. Once this is mailed, the exclusion becomes effective 20 days later for that individual. When your organization or you have been put on the exclusion list, it means that you won’t be able to participate in Federal healthcare programs such as Medicare and Medicaid any longer. Providers, in order to be in compliance, will not hire you. But reinstatement is possible.

Healthcare Sanctions When Excluded from OIG

It is possible to be reinstated and get off the OIG List and not have healthcare sanctions in the form of penalties hanging over you any longer. It takes some work, but it can be done. First you would appeal it to the HHS Administrative Law Judge. If getting an adverse decision there, you can then appeal it to the HHS Departmental Appeals Board also known as the DAB. If not happy with the final decision of the DAB, you can then get a judicial review done in Federal Court. Every case takes into consideration healthcare compliance and sanctions related to the Social Security Act.

If an individual was excluded by the OIG under section 1156 of the Social Security Act, he or she can request a hearing if Federal program services are being delivered to more than 50 percent of that person’s patients and in a rural area where there is a shortage of health professionals. When the individual has received a written notice of exclusion, he or she may file a special request in writing for a hearing before the HHS Administrative Law Judge within 15 days of when the notice was received. Having an attorney guide you through the procedure is a good idea.

Legal Assistance

Contact Chelle Law for assistance in removing your name from the OIG Exclusions List.