{"id":27,"date":"2007-03-26T22:49:07","date_gmt":"2007-03-26T22:49:07","guid":{"rendered":"http:\/\/www.sentrylink.com\/blog\/2007\/03\/26\/medical-background-checks-and-the-oig-exclusions-list\/"},"modified":"2021-06-29T12:40:46","modified_gmt":"2021-06-29T16:40:46","slug":"medical-background-checks-and-the-oig-exclusions-list","status":"publish","type":"post","link":"https:\/\/www.sentrylink.com\/blog\/2007\/03\/26\/medical-background-checks-and-the-oig-exclusions-list\/","title":{"rendered":"Medical background checks and the OIG exclusions list"},"content":{"rendered":"

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

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”<\/q>. 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>:<\/p>\n

…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.<\/q><\/cite><\/p>\n

and more ominously:<\/p>\n

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.<\/q><\/cite><\/p>\n

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<\/a>. 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.<\/p>\n

What gets someone on to such a list? Here is the list of exclusion reasons<\/a>. 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.)<\/p>\n

Any employer providing patient care should use the OIG exclusions list. However, it does not substitute for a full criminal background check<\/a>. Used together, they can help provide a safety net for patients and residents.<\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"

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 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[3],"tags":[],"class_list":["post-27","post","type-post","status-publish","format-standard","hentry","category-employment-screening"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.sentrylink.com\/blog\/wp-json\/wp\/v2\/posts\/27","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.sentrylink.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.sentrylink.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.sentrylink.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.sentrylink.com\/blog\/wp-json\/wp\/v2\/comments?post=27"}],"version-history":[{"count":2,"href":"https:\/\/www.sentrylink.com\/blog\/wp-json\/wp\/v2\/posts\/27\/revisions"}],"predecessor-version":[{"id":426,"href":"https:\/\/www.sentrylink.com\/blog\/wp-json\/wp\/v2\/posts\/27\/revisions\/426"}],"wp:attachment":[{"href":"https:\/\/www.sentrylink.com\/blog\/wp-json\/wp\/v2\/media?parent=27"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.sentrylink.com\/blog\/wp-json\/wp\/v2\/categories?post=27"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.sentrylink.com\/blog\/wp-json\/wp\/v2\/tags?post=27"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}