OIG Screening : Why It’s More Than Just a Background Check

Perhaps you're working in the medical industry in an area such as human resources or practice management and have been feeling overwhelmed with a long list of tasks. With all the issues in healthcare today ranging from lack of personnel to inadequate patient satisfaction scores and concerns over billing errors, the process of ensuring compliance may seem like "checking off another box".

One area of compliance that is extremely important to ensure the safety of your patients and the survival of your business is OIG screening. While it is common to hear people refer to OIG screening as a background check or exclusion check, they are completely different concepts. A background check identifies whether an individual has a criminal history, while an OIG exclusion check identifies whether an individual has been excluded from participation in the Medicare and Medicaid programs by the federal government.

This article will provide readers with a simple and concise explanation of the OIG exclusion check along with the information you must have to comply with the federal regulations regarding OIG exclusion checks.

What is the "Exclusion List"?

The Office of Inspector General (OIG) produces a List of Excluded Individuals/Entities (LEIE) which serves as a federal "Do Not Hire" list. Individuals are added to this list for serious reasons including Medicare fraud, patient abuse, felony drug charges, or having delinquent student loans.

In addition, when someone is added to the LEIE list they are considered "excluded".

The government mandates that you may not pay anyone on the LEIE with any federal funds. If your organization bills Medicare, Medicaid or Tricare, you cannot employ an excluded individual.

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Who Needs to be Screened?

Many practices mistakenly think that the only people they have to screen for exclusion from payment are their physicians/nurse practitioners/therapists who directly interact with patients. However, this is inaccurate as the OIG has established many broad exclusions for individuals and entities involved in providing care or submitting claims. The following individuals may need to be reviewed during your exclusion screening process:

- The individual at the front desk receiving patient check-in.

- The billing employee who assigns codes to claims.

- The temporary employees from a staffing agency working on a temporary basis for your practice.

- Administrative employees at your practice.

If a staff member, like an excluded administrative assistant, assists in preparing a bill that will be filed with Medicare, you are technically accepting liability. For this reason, in addition to screening your provider employees, you need to perform exclusions screening on all your employees as well as your contractors and vendors.

Why Is This So Risky?

It may seem unlikely that you might actually employ any of the people on the list but it is not as unusual as you think and if you make this mistake the financial ramifications could be considerable. If an OIG investigation establishes that you have employed an excluded individual(s), Civil Monetary Penalties could be imposed on your company. These penalties can reach upwards of $20,000 for each claim and/or item/service and will also include three times the amount of damages awarded to the complainant. The potential exposure to a busy medical practice can reach the hundreds of thousands of dollars in a short timeframe.

The "Once and Done" Trap

The greatest wrong that many organizations commit is treating OIG screening as a one off event. Most human resource departments run an OIG screen on a newly hired employee their first day and they see that they are clear and do not check them again.

The issue is that the OIG continues to update their list each month, so an employee could be perfectly clear on the first of January, but on June 30th they could have lost their license or been convicted of a crime. If you weren't checking that employee each month, you wouldn't know that they had been added to the OIG list and you would continue to bill for their services while you accumulate fines against your business every day.

In order to stay in the "safe harbor" zone, you would need to be checking employees for OIG eligibility each month.

The Bottom Line

Compliance may not be the most stimulating aspect of healthcare, yet it remains the foundational aspect of your organization that maintains your operations.

Automatically, by completing a monthly review of everyone on the excluded list, you are protected from financial penalties; you are maintaining the ethical and professional standing of every employee in your organization — from your doctors to your billing specialist. This protects both your revenue and, more critical, your patients — those who utilize the resources provided by your organization.