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

Requirements

“Many providers that furnish items and services on the basis of orders or prescriptions, such as laboratories, imaging centers, durable medical equipment suppliers, and pharmacies, have asked whether they could be subject to liability if they furnish items or services to a Federal program beneficiary on the basis of an order or a prescription that was written by an excluded physician. Payment for such items or services is prohibited. Providers should ensure, at the point of service, that the ordering or prescribing physician is not excluded.” OIG Special Advisory Bulletin on the Effect of Exclusion From Participation in Federal Health Care Programs (May 8, 2013) p.8

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

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.
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

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