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:
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.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
“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
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?
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.
“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.
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.
It is very difficult to verify MD’s. If a MD is found on the list, there is no way to verify them by way of social security number. I am sure if I called the MD’s office for his social security number he/she would not provide it to me.
Also, there has never been any mention of exactly how an agency could show proof that a check was conducted. I print the results from the checks conducted, however with all the employees and MD’s that we must check each month I have to figure out were to store over 500 pages per month.
There needs to be more information provided regarding the checks.There is tons of information on how an agency will not get paid. Not to add how difficult it is to read all the results if you were to print out the list of excluded individuals. Something better has got to be done!
It is an awful list,
I got put on the list for not paying the Loan,
The Loan collectors gave me the wrong information that I had zero options to work out the loan situation except pay 100$ in 1 payment.
So Off to default I go. I had no idea I was able to rehabilitate my loan either. So it sat there on the list again when I was willing to pay.
Then as time went by I got very sick & my loan debt was canceled but still on list
The list is unfair,
however,
You should be able to get removed.
most of the violations can be removed after 3-5 the very serious violations in 10 years.
The folks that get put on due to not paying loan can be removed IF they agree into loan rehab in 12 months.
My guess is that many folks are eligible to be removed yet don’t know how to request.
I know someone that was on for a minor violation they say there for 10 years only because they had no idea to request removal.
Can you come off this list prior to the 5 year limit? My conviction will be 5 years in March, however they placed me on the list later and the five years will not run out until september.
Are you required to do OIG Sanction checks on your volunteers?
Be aware. There is a archive Exclusion List. Even though, I am no longer on the OIG Exclusion list for defaulted school loan. I am obviously on the archive list. And this has resulted in job offer(s) being receded. Appearance on the archive list is being interpreted as current status. Explaining this to the HR department and potential employers has been futile. I am still unemployed in my profession.
I was barred from state medicais program in 1988, since hten I moved to another stated and employeed, recently on a monthly exlcusion list verification my name popped up, my employer has placed me on administrative leave, till i get clearence from a specific agency’s exclusion list. I have not participated in medicaid program in 22 years. Please anyone who can help me to clear my record excpiditiously. so that I can make honest living. thank you
Is it possible for a person to apply to be taken off the OIG list and be removed if that person worked during the excluded period without understanding they were not supposed to be working?
This list simply a standard for legalized descrimination! I’m a pharmacist and have been on the list since 1999. I’ve been working for staffing agencies only because nobody will hire me. I cannot get off the list because most of the facilities I have worked at through my agency are medicare/medicaid providers. Kind of like being in the proverbial “rock and a hard place” Any suggestions?
I am a pharmacist in Texas on the OIG list. My five year sanction is over in August 2012. I plan to apply for reinstatement but I was wondering if any had gone through this procedure. Has anyone been able to find any type of employment in this field with this “Scarlet Letter” on his/her chest?
Dan B. most restrictions last for 5 to 10 years. Have you looked into reinstatement. I tried the staffing agency route as a pharmacist and it did not work for me.
Fighting the OIG is Like trying the devil,s case in hell.All information to make an appeal is given but the end result remains unchanged, 5 yrs exclusion.How much more truthful can one be.I worked for an agency ,I later found out, was noted to recruit newly arrived unlicensed US foreign nurses, with the intention that they become licensed within a year.The agency was charged with medicaid fraud and all the nurses were implicated.Imagine being charge for a crime one knew nothing about, even the existence of something called medicaid, much less to be stealing from it.The home care job description was far below the level of our education and overseas title.Guardians of care receivers were highly impressed with the services rendered.The lawyers with huge fees were just going through the motion and sometimes oblivious to the court proceedings.We were taken to court for being unlicensed and yet had to pay the penalty for unblemished licenses.How much more frustrating can this be for us loyal and faithful nurses seeking the “American dream”.
My uncle has completed his 5 year debarment. He applied for reinstatement more than nine months ago he has not heard from OIG. What other things can he do? more so the 120days time frame has passed.
I am curious as to the difference, and if there is a difference, between Medi Cal Suspension list and OIG. I currently received
a letter stating I am on Medi Cal Suspension List. I was an RN that surrendered my license due to inability to pay for all the rehab programs for probation
They are different lists. Media-cal is specific to California, OIG is not, and it is possible for an individual to be on one list and not the other.
I am on the list and I am a physician. This list has blocked me from employment in certain circumstances in the past but have received waivers. It is not true that the list will prevent you from working jobs outside health care such as Walmart. That is probably the regular background check. I am a licensed school teacher now and it definitely wasn’t easy going through the process of returning to work after being lost in addiction for 15 years. There will always be ghosts that will come back to hunt me.