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Mar

26

Medical background checks and the OIG exclusions list

Filed Under Employment screening |  by Erica S. Kane

Certain professions require more specialized screening than the traditional background check. Medical providers fall into this category. In this post we explore the medical exclusions database provided by the U.S. Office of the Inspector General (OIG), and how it is used for medical employment screening.

The OIG exclusions list is a powerful tool established by Congress to “prevent certain individuals and businesses from participating in Federally-funded health care programs”. Specifically, the Federal government will not pay for any items furnished, ordered, or prescribed by an excluded person or business. Violations of this policy can be quite costly, at $10,000 per incident, and up to three times the cost of the service. It also goes beyond the obvious services such as those provided by doctors; ambulance drivers also fall under these provisions. Since the government controls the majority of the national health budget through Medicare and similar programs, this is tantamount to cutting off the target’s ability to work in virtually any medical setting. As stated in the OIG special advisory bulletin:

…A provider or entity that receives Federal health care funding may only employ an excluded individual in limited situations. Those situations would include instances where the provider is both able to pay the individual exclusively with private funds or from other non-federal funding sources, and where the services furnished by the excluded individual relate solely to non-federal program patients…In many instances, the practical effect of an OIG exclusion is to preclude employment of an excluded individual in any capacity by a health care provider that receives reimbursement, indirectly or directly, from any Federal health care program.

and more ominously:

Providers and contracting entities have an affirmative duty to check the program exclusion status of individuals and entities prior to entering into employment or contractual relationships, or run the risk of CMP [civil money penality] liability if they fail to do so.

It is clear that hospitals and medical schools are not the only employers who have to worry about this list. Nursing homes, medical supply companies, and many others need to use it. Fortunately, it is quite simple to check if a person or a business is on the database. The OIG provides online access to the excluded party list. An initial search is done by name; if a potential match is found, the system will ask for a social security number (SSN) or an employer identification number (EIN) to confirm identity. It is a measure of how seriously the government considers medical fraud, that they have made this database so easy to use. It is very different from typical public records. Best of all, it is free.

What gets someone on to such a list? Here is the list of exclusion reasons. The majority of them deal with fraud, not surprisingly, but also include substance abuse and patient neglect, all particular risks in the health-care arena. (Students, be warned: defaulting on loans or scholarship obligations can also get you on the list.)

Any employer providing patient care should use the OIG exclusions list. However, it does not substitute for a full criminal background check. Used together, they can help provide a safety net for patients and residents.

Comments

5 Responses to “Medical background checks and the OIG exclusions list”

  1. Page Watkins on November 18th, 2008 5:38 pm

    “the list of exculsion reasons” link in the second to the last paragraph on this webpage does not work. This infomation is not found using the search box or site map, that I can find either. Please advise me on how to access this list.

    Thank you,

    Page Watkins RN, BSN, CCRN
    Assistant Director CVICU/CICU
    University Medical Center
    Lubbock, Texas

  2. Connie on March 29th, 2009 1:08 am

    I am on the exclusion list and haven’t been able to work for 5 years even though the original conviction that put me on the list was dismissed in a Court of Appeals. I can’t get unemployment, I can’t even work at Wal-Mart.

    I’ve appealed to the OIG explaining that my case was dismissed and they never responded. I’ve talked to Lawyers who basically know nothing of the subject other than to get my record expunged. However, that won’t get me off the OIG list.

    I’ve interviewed for numerous wonderful jobs only to be told that I am unemployable once a background screen is done. I believe that this injustice has befallen on me by the OIG and they don’t care or are too big to keep up with their rules enforcement and control.

    I spent my life savings defending myself in Court only to find that it was a complete waste of time. It’s maddening to think that I could be working, yet I am prevented doing so by a bureaucratic mess.

    I would like some answers but cannot find anyone to ask. Can anyone help me?

  3. John on August 17th, 2009 11:17 am

    Connie

    Did you get your problem resolved? You should contact OIG directly and your Congressional representatives.

    Reinstatement of excluded entities and individuals is not automatic. Those wishing to again participate in the Medicare, Medicaid and all Federal health care programs must apply for reinstatement and receive authorized notice from the OIG that reinstatement has been granted. Obtaining a provider number from a Medicare contractor, a State agency or a Federal health care program does not reinstate eligibility to participate in those programs. There are no provisions for early or retroactive reinstatement. Upon written request to the OIG at the below listed address, the OIG will provide Statement and Authorization forms which must be completed, notarized and returned. The information contained in these forms will be evaluated and a written notification will be sent indicating the final decision of the OIG pertaining to the reinstatement request. Generally, this process requires up to 120 days to complete, but can take longer if circumstances warrant.

    Excluded parties may write to the OIG within 120 days of the expiration of the minimum period of exclusion to request reinstatement. Premature requests will not be considered.

    If reinstatement is denied, the excluded party is eligible to reapply after one year.

    To apply for reinstatement, send a request to:

    HHS, OIG, OI
    Exclusions Staff
    7175 Security Boulevard, Suite 210
    Baltimore, MD 21244

    Additional information in regulations can be found at 42 CFR 1001.3001-3005.

  4. Joseph Williams on November 16th, 2009 11:31 am

    “An initial search is done by name; if a potential match is found, the system will ask for a social security number (SSN) or an employer identification number (EIN) to confirm identity. ”

    The above statement is inaccurate in my experience. I was mistakenly put on this list because of issues my father had with his license (both MD’s). The supposed infraction occured a year before I finished medical school. They obviously did NOT check DOB, SS# otherwise they would have recognized the discrepancies. My father died in 1996 as well.

    This list is a powerful and dangerous tool in my opinion.

  5. Kimberly Buchanan on November 23rd, 2009 5:16 pm

    My husband is currently on the exclusions list because of a past drug addiction after the loss of our newborn son. He has no intentions of going back to the medical field, and has been clean ever since. Yet his name is on this list. We are currently trying to buy our first home. Because it is a federal government loan we cannot get approved because of his name being on this list. This list goes far beyond health care benefits. You will not be able to get any type of federal aid.

    Does anyone know how to get your name off of this list? I know that you can get a reinstatement but that is if you are going back to the medical field. What if you are not EVER planning on practicing medicine again, how do you get off the list at that point.

    Any information would be greatly appreciated, we have hit a wall with this issue, all we want to do is be able to buy a home for our family.

    Thank you.

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