How to Protect Your Business Using the Exclusions List OIG

Working in the healthcare industry means you must follow many rules, not just for patient care but for the business side as well. One of the most critical topics for providers and hiring managers is exclusion. While it sounds technical, the concept is actually very simple to understand. However, ignoring it can lead to massive financial losses for your organization. The Office of Inspector General (OIG) is tasked with fighting fraud in federal programs like Medicare and Medicaid. To help keep these systems safe and honest, they established the Exclusions List OIG.

The Exclusions List OIG is like a "do not hire" list. It contains the names of individuals and entities that have been excluded from participating in federal healthcare programs. Exclusions can occur for a number of different reasons. The most common reasons for an exclusion include having a conviction related to Medicare fraud, having an abuse conviction related to patients, or having a felony conviction related to healthcare. Other reasons for exclusion may include financial misconduct, or failing to repay a student loan.

For a clinic, hospital, or pharmacy owner, this is incredibly important. If you hire someone who has been located on this list by the OIG, and that person provides any sort of care or administrative work that is paid for with either Medicare or Medicaid funding, you are putting yourself in a very precarious position with the government. The government treats this as a serious violation of Federal law.Repercussions include paying large fines — sometimes in the thousands for each item you claim — and sometimes being required to return any funds received.

To avoid these matters, OIG Checks should be part of an employer's standard procedures for hiring all healthcare personnel. Prior to offering employment to a nurse, physician, billing, or reception employee, you should search their names in the OIG database for the OIG list. This is a simple way for you to secure your practice.

But you must do it more than once. It is possible for someone to have a clean record when hired, but to have been in legal trouble 6 months later. Due to the continual updates to the listing, experts in compliance advise that all healthcare employers should complete a check of all employees every month.

It doesn't have to be hard to perform an OIG Exclusion screening. There is a database that can be accessed online, and large companies can use software to do the screening without doing the manual labor of searching. The objective of the screening process is to make sure that all the money that comes into your company is from legitimate sources and that you are not inadvertently hiring someone who has been excluded from the system.

In short, the best way to remain compliant is to be diligent. If you are aware of the OIG Exclusions List and ensure that all of your employees are not OIG Excluded, you will protect your business's image and finances. It is essential to conduct regular OIG Checks so that you can put your attention on the most important thing: giving the best possible care to your patients, without the fear of facing legal repercussions.