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Excluded Party List Searches – How Often To Search Program Exclusion List

Excluded Party List Searches

OIG Advisory Further Defines Provider Obligations 

Excluded party search exclusion listsIn our compliance legal practice, questions often arise about an employers’ obligations to screen employees to determine whether they have been excluded from federal health care programs.  The significance of hiring or entering a contract with a party who has been excluded from participation cannot be overstated.  Providers can be subject to civil monetary penalties for even employing or contracting with excluded parties.  Reimbursement is also denied of based on services performed or ordered by an excluded party.  The financial implications of erroneously hiring an excluded individual can be astronomical; particularly if the excluded party is permitted to work without detection for a long period of time.

In order to prevent this potential exposure, employers need to actively monitor the Office of Inspector General’s exclusion database.  Employers and contractors should operate a systematic program to screen all employees and contractors before hire.  Exclusion and other background searches should be operationalized into your hiring process and into your regularly performed compliance activities.

Even after hire, periodic searches should be performed on all employees and contractors.  Past wisdom advised checking each employee at least annually.  Current practice is to check for exclusion on a monthly basis.  More frequent screening is supported by an updated Special Advisory Opinion that was released by the OIG in May of 2013.  The OIG Special Advisory stresses the need for providers to perform frequent searches and to fully document the searches and any investigation that is necessitated by the results.

External contractors are often used by larger providers to conduct and report on periodic exclusion screenings.  Provider should be aware that contracting out screening functions does not exclude them from primary responsibility.  In other words, if something is missed, it is the provider’s “neck on the block,” not the screening company’s, at least in the eyes of the OIG.

Look for further posts on the healthlaw-blog covering excluded parties.  If you have any questions about these issues, contact health care and compliance attorney John H. Fisher, II through the contact information provided on the blog or through our law firm website.  You can also visit our compliance blog at for more information specific to compliance program development and operation.

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John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
500 First Street, Suite 8000
P.O. Box 8050
Wausau, WI 54402-8050

Tel 715.845.4336
Fax 715.845.2718

Ruder Ware is a member of Meritas Law Firms Worldwide

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