Understanding OIG Screening: A Simple Guide for Healthcare Providers

Workers in Healthcare have likely encountered OIG Screening before. However, not many individuals truly understand what exactly OIG screening involves; thus let’s simplify.

Defining OIG Screening

To begin with, OIG is short for the Office of Inspector General, the federal agency that regulates and supervises all the healthcare programs that the Federal Government manages, specifically Medicare and Medicaid. OIG Screening refers to the OIG’s screening of an individual to determine whether the individual is a qualified healthcare worker or organization or if that individual can receive reimbursement from one of these two government-based health care payment systems.

To put it another way; it is an OIG-sponsored background check of all healthcare workers and their Medical facilities; its primary purpose is to ensure patient safety and prevent fraud against the Federal Healthcare systems.

What Is the Purpose of the OIG Check? 

Conducting an OIG check on healthcare employees and contractors protects patients and healthcare organizations in many ways, including:

If a person is excluded from a federal health care program that person cannot receive payments from either Medicare or Medicaid. When a hospital or clinic employs an excluded person, the facility may be subject to huge fines. These penalties can run into the thousands of dollars.

To avoid being penalized, all healthcare facilities must verify that their employees, contractors, and vendors are not on an exclusion list. This includes not only physicians and other practitioners working directly with patients but also staff responsible for collecting money from patients or for cleaning the facility.

Defining OIG Exclusions

The Office of Inspector General (OIG) creates an OIG exclusion when an individual has been barred from participating in any federally operated healthcare programs. This is no small matter.

Individuals may be excluded from participation in these federally operated healthcare programs for a number of reasons, including (but not limited to):

• Fraudulent Billing

• Abuse or Neglect of Patients

• Drug-Related Convictions

• Revocation of Licenses

Once an individual has been excluded, he/she can neither bill Medicare nor operate in any capacity that utilizes federally operated healthcare programs. For example, anyone who has been excluded cannot staff an employee working for a federally funded facility or provide services to Medicare patients.

Length of OIG Exclusions

OIG exclusions can have a term length of five years, ten years, or indefinitely depending upon the nature of the offense. The amount of time an OIG exclusion will be in effect is dependent upon the offense the individual committed.

During the time an individual is subject to an OIG exclusion, he/she will be unable to work in the majority of the healthcare field. Therefore, being the subject of an OIG exclusion can significantly restrict an individual’s ability to earn a living in the healthcare profession.

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How do I conduct an OIG check?

The OIG has created a freely accessible online resource known as the List of Excluded Individuals and Entities (LEIE) which allows you to perform an OIG check.

Follow these steps to perform an OIG check:

1. Visit an OIG website.

2. Input the name of the person you are searching for.

3. Review the results.

4. Document your findings.

This process can take just a few minutes. This is a quick way to prevent any issues for your organization due to employing the wrong person.

How frequently should you conduct screenings?

The majority of experts recommend conducting an OIG screening of all employees and contractors on a monthly basis. Some companies do this on a quarterly basis and at a minimum, every employee or contractor should be screened at least one time per year.

When hiring a new employee or contractor, it is essential to complete the OIG check prior to their start date. You should perform the OIG check while you are still in the hiring process so you are aware of any issues prior to allowing that individual to start working.

What happens when you have an exclusion?

If you find an exclusion during your OIG check, you must act immediately. If the excluded person is working for you in any way related to federal healthcare programs, you must terminate employment immediately.

If you retain an excluded person on staff, your organization may experience:

• Severe penalties including large fines for every claim submitted.

• Loss of permission to participate in Medicare Medicaid.

• Possibility of criminal prosecution for serious violations.

• Decreased credibility for your organization.

Proper Documentation

It is essential to document all of your OIG screening efforts. The following are records that you should maintain:

• The date that you completed your check

• Individuals who were screened

• Outcome of each screening

• Any action taken

Maintaining these records provides documentation of your compliance with the OIG’s screening requirement and will assist in protecting you during audits or investigations.

Make Screening A Habit

OIG screening must be included as part of your compliance program. You should create a process that works for your operation. Some organizations will utilize automated services that will check the OIG database each month and send you notices of matches.

On the other hand, there are organizations that have employees manually check the database for potential matches. Regardless of the process that you decide to use, it is imperative to have a consistent and reliable method of screening.

Final Thoughts

OIG screening, OIG checks, and understanding OIG exclusion are essential for healthcare organizations. They're not optional extras. They're requirements that protect patients, staff, and your organization.

The process is straightforward and free. Taking a few minutes each month to verify your team members can prevent devastating financial and legal consequences. Make OIG screening a priority in your workplace today.