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Posts Tagged ‘excluded parties’

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

Saturday, March 15th, 2014

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.

Excluded Party Screening – Compliance Program Key Element

Tuesday, February 14th, 2012

Screening For Excluded Providers
Key Elements Of Your Compliance Program

Most hospitals and larger healthcare organizations have gone through the process of developing compliance programs and are aware of the prohibitions against entering relationships with parties who have been excluded from a federal health care program.  Smaller organizations may not be aware of their responsibilities to screen all employees, vendors and contracting parties for exclusion.

Providers, such hospitals, medical groups, ambulatory surgery centers and home health agencies are subject to civil monetary penalties for submitting claims for healthcare items or services that are provided by excluded individuals or companies.  Fines can reach as high as $10,000 per item or service.  The fines can be astronomical if goods or services are regularly provided by the excluded party.

For this reason, compliance programs will generally include policies and procedures that require screening prior to contracting or employment.  Regular periodic screening is also highly recommended.  Smaller organizations and physician practices are at the most risk of violating these provisions.  These organizations have generally not yet faced the creation of formal compliance programs; although compliance programs will be mandatory in upcoming years.

 All health care providers must establish policies and procedures to be certain that they do not contract with excluded parties.

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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