Highlights from ProviderTrust: OIG Special Advisory Bulletin Provides Guidance on Required Health Care Provider OIG Exclusion List Searches for Individuals and Entities

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On May 8, 2013, the OIG released the Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs. ProviderTrust provides solutions to complete OIG exclusion list checks for providers.

Office of Inspector General

OIG updates the LEIE monthly, so screening employees and contractors each month best minimizes potential overpayment and CMP liability.

Highlights from the Special Advisory Bulletin include:

1. The Special Advisory Bulletin indicates that providers should check the OIG List of Excluded Individuals and Entities (LEIE) upon hire and periodically for employees and contractors. The OIG notes that there is no statutory requirement to search the LEIE exclusion list, but that the OIG updates the LEIE exclusion list monthly "so screening employees and contractors each month best minimizes potential overpayment and Civil and Monetary Fines".

2. The Advisory recommends that Providers review job descriptions, categories of care, and contractual relationships to determine whether an item or service being provided is "directly or indirectly, in whole or in part, payable by a Federal health care program. If the answer is yes, the best mechanism for limiting CMP liability is to screen all persons that perform under that contract or that are in that job category".

3. The Special Advisory Bulletin explains that no Federal health care program payment can be made for items or services beyond patient care, and includes those for administrative, transportation, filling prescriptions, inputting prescription information, preparation of surgical trays or reviewing treatment plans, regardless of whether such services are separately billed or are included in bundled payment.

4. The Special Advisory Bulletin explains that the prohibition for payment applies to administrators such as executives, human resources, information technology, accounting, general counsel and office managers who are on the OIG exclusion list.

5. The Special Advisory Bulletin advises that a hospital contracting with a staffing agency is required to ensure that the staffing agency has conducted OIG LEIE exclusion list searches on such staff. Guidance is provided that the hospital can reduce civil and money penalties (CMPs) if it can demonstrate that it reasonably relied on the staffing agency to perform OIG LEIE exclusion list checks on all agency providers regularly and recommends that the provider obtain supporting documentation. The hospital is responsible for civil and money penalties if the hospital does not ensure proper OIG exclusion list checks are performed regularly.

NOTE: The Advisory indicates that the OIG will be adding NPI data for individuals and entities excluded after 2009 if they have an NPI and will include information regarding waivers of exclusion granted by the OIG. This will allow for an additional verification mechanism separate from the SSN or Tax ID.

If you have any questions or would like to review your OIG exclusion list compliance program, please contact us at http://www.providertrust.com, or call us at 615-938-7878.

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Mike Rosen

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