I look at having a third party vendor screening for you like an insurance policy. This wouldn't have happened if they had a system in place to search all the federal and state exclusion databases on a monthly basis.
Howell, NJ (PRWEB) December 09, 2014
Last month, UCLA Health System was fined $470,000 by the Office of the Inspector General for allowing an anesthesiologist on the OIG exclusion list to treat patients and bill federal health care programs like Medicare for his services.
Individuals convicted of certain crimes can be placed on the OIG's list of excluded individuals/entities, or the LEIE. This means that the government can refuse to pay out when services offered by these individuals or entities are billed to Medicare, Medicaid, or any other federal healthcare program.
According to an Oct. 23 article from the Los Angeles Times, which received their information through a Freedom of Information Act request to the U.S. Department of Health and Human Services, Dr. John Edward Miller was placed on the LEIE in 2003 but worked at Ronald Reagan UCLA Medical Center from April 2009 to Nov. 2013. Miller's license was originally suspended.
"His license was reinstated in 2008 but he wasn't taken off the list of excluded individuals until December 2013," explained Steven Grossman, Director of Marketing at Streamline Verify. "You see that having your license reinstated isn't enough you have to actually have yourself removed from the LEIE."
Though, according to the LA Times, UCLA claims that it only discovered Miller's exclusion this year and disclosed it immediately, the Inspector General determined that UCLA should have known about their employee's status and fined them accordingly.
"From the last few large fines the OIG levied it looks like the healthcare organization was informed by a government agency of their wrong doings," Grossman said. "It appears that one of the first things companies do after getting a random audit from the Federal OIG is check to make sure they aren't currently employing an excluded individual and that they didn't employ one in the past."
Though the university is looking into the software problems they say led to the mistake, Grossman is concerned that proper systems weren't in place to begin with. "What amazes me is how such a large corporation didn’t have a simple software in place to monitor their exclusion screening," he said. "From our experience, finding matches against the federal database is simple; the federal OIG is one of the easiest databases to navigate through."
Streamline Verify offers third-party software solutions to organizations that need to screen regularly for OIG compliance.
"I look at having a third party vendor screening for you like an insurance policy," Grossman said. "This wouldn't have happened if they had a system in place to search all the federal and state exclusion databases on a monthly basis."
About Streamline Verify
Steamline Verify offers fail-safe, guaranteed OIG compliance with their screening process. Steamline Verify offers an exclusion screening process that is reliable, user-friendly, efficient, and affordable. To learn more, visit http://www.streamlineverify.com