Does your practice regularly check exclusion lists? Your practice could incur millions of dollars in fines from the Office of Inspector General (OIG) if you do not. Check your managed care contracts as they may require exclusion list screenings, especially contracts involving Medicare Part C. So please, implement regular exclusion list screenings for your providers this year! Even if you already do exclusion list screenings, use this Compliance Checkup to ensure that your screenings are regular and comprehensive. Here’s what you need to know.

What are the exclusion lists?

A person or entity can be excluded by the OIG or by a state Medicaid agency. The exclusion lists to check are:

  • The OIG’s List of Excluded Individuals/Entities
  • The General Services Administration’s System for Award Management
  • State Medicaid exclusion lists (at least forty states maintain their own lists)

The OIG has mandated that healthcare organizations do not hire or do business with an excluded individual or entity, as described in a 2013 Special Advisory Bulletin. Inspector General Daniel Levinson has stated that it is his recommendation and best practice to search the OIG exclusion list monthly because the records are updated monthly.

Why should my practice check the lists?

Civil fines and monetary penalties can be assessed by the OIG for hiring or doing business with excluded individuals or entities. Fines and penalties include the following:

  • $10,000 per each item claimed or services provided
  • Treble damages
  • Exclusion
  • Loss of the right to bill Medicare and Medicaid
  • Additional fines under the False Claims Act (penalties up to $11,000 per claim, and possible placement in a Corporate Integrity Agreement with the OIG)
  • Criminal fines and/or jail time

You should check all employees, subcontractors, and vendors against the exclusion lists prior to hiring or contracting and then recheck monthly thereafter. In 2017, the OIG collected $1.7 million dollars from provider self-disclosure settlements and nearly $820,000 in civil monetary penalties from providers. This is why regular and comprehensive exclusion list checks are necessary for your practice.