OIG imposes large fines, monetary penalties and possible program exclusion upon providers that employ or enter into contracts with excluded persons or entities to provide items or services payable by Federal health care programs.

Requirements

“BBA (Balanced Budget Act, 1997) authorized the imposition of CMPs (Civil Monetary Penalties) against providers that employ or enter into contracts with excluded persons to provide items or services payable by Federal health care programs. If a health care provider arranges or contracts (by employment or otherwise) with a person that the provider knows or should know is excluded by OIG, the provider may be subject to CMP liability, if the excluded person provides services payable, directly or indirectly, by a Federal health care program. OIG may impose CMPs of up to $10,000 for each item or service furnished by the excluded person for which the Federal program payment is sought, as well as an assessment of up to three times the amount claimed, and program exclusion.”

“A provider could be subject to CMP liability if an excluded person participates in any way in the furnishing of items or services that are payable by a Federal health care program…including direct patient care, indirect patient care, administrative and management services, and items or services furnished at the medical direction or on the prescription of an excluded person when the person furnishing the services either knows or should know of the exclusion.”

“CMP liability could result if the provider’s claim to the Federal health care program includes any items or services furnished by an excluded person, even if the excluded person does not receive payments from the provider for his or her services (e.g. a non-employed excluded physician who is a member of a hospital’s medical staff or an excluded health care professional who works at a hospital or nursing home as a volunteer).”

“An excluded person may not provide services that are payable by Federal health care programs, regardless of whether the person is an employee, a contractor, or a volunteer or has any other relationship with the provider.

For example, if a hospital contracts with a staffing agency for temporary or per diem nurses, the hospital will be subject to overpayment liability and may be subject to CMP liability if an excluded nurse from that staffing agency furnishes items or services to Federal health care program beneficiaries.” OIG Special Advisory Bulletin on the Effect of Exclusion From Participation in Federal Health Care Programs (May 8, 2013)10-12

Guidelines for health care providers to screen employees, contractors and vendors monthly against LEIE exclusion list.
April 8, 2016

Items and Services that Excluded Parties May Be Furnishing Which Will Subject Their Employer or Contractor to Possible Civil Monetary Penalty (CMP) Liability
April 8, 2016

Medicare/Medicaid payments are prohibited to providers who furnish any items and services at the medical direction or on the prescription of an excluded person.
April 8, 2016

Providers are responsible to ensure that the ordering or prescribing physician is not excluded from participation in Medicare/Medicaid.
April 8, 2016

CMS Licensure Requirements for Medicare and Medicaid Providers and Suppliers
April 8, 2016

OIG recommends contractors be screened by providers or validate that the contractor is conducting proper screening on behalf of the provider to avoid liability.
April 8, 2016