Penalties for Employing Excluded Individuals
Penalties for Employing Excluded Individuals A recurring theme in recent OIG enforcement is the imposition of Civil Monetary Penalties (CMPs) for healthcare providers who employ individuals or entities that are excluded from participating in federal healthcare programs. Recent findings include: A Urology Group that paid a settlement for allegedly employing an excluded individual. A Skilled Nursing Facility that agreed to a multi-million dollar settlement for employing multiple excluded individuals. A Home Health Agency and several other healthcare providers that paid CMPs for similar violations. These cases highlight that even if a provider isn’t directly involved in fraud, the failure to perform robust and continuous exclusion screening can result in significant financial liability. Audits Exposing Financial Misconduct The OIG’s audit reports frequently uncover billing errors and financial mismanagement. A recent audit found that a company, Companion Data Services, LLC, claimed both allowable and unallowable Medicare costs through its incurred cost proposals. Such findings underscore the importance of meticulous financial auditing and oversight. Other audit reports have targeted issues such as: Inappropriate Billing for Services: Audits have identified healthcare providers, including a psychotherapy provider, who submitted claims for services that were not actually provided. This type of non-compliance often leads to fines and recoupment demands. Kickback Schemes: Recent enforcement actions have targeted individuals and companies involved in schemes to pay kickbacks for Medicaid referrals, leading to convictions and prison sentences. These cases, which often arise from whistleblower reports, show the OIG’s focus on the illegal inducement of patient referrals. Patient Safety Violations: The OIG also focuses on patient safety. A recent audit report highlighted that Medicare enrollees left acute-care hospitals against medical advice at increasing rates, indicating potential patient care and discharge planning issues. Other enforcement actions have addressed Emergency Medical Treatment and Labor Act (EMTALA) violations, where hospitals failed to provide proper medical screening examinations. Key Takeaways for Compliance Programs These latest OIG findings reinforce the recommendations from the previous articles on compliance. Organizations should: Strengthen Exclusion Screening: Go beyond an initial check and implement a continuous, automated screening process for all employees, contractors, and vendors against federal and state exclusion lists. Conduct Proactive Audits: Regularly audit billing, coding, and financial records to identify and correct errors before they are flagged by the OIG. Encourage a Culture of Compliance: Promote a work environment where employees are trained to identify and report wrongdoing without fear of retaliation, as many OIG cases originate from insider information. The OIG’s enforcement actions demonstrate a clear and unwavering commitment to holding non-compliant entities accountable. By learning from these examples, healthcare organizations can proactively fortify their compliance programs and avoid becoming the subject of a future OIG report.