What is OIG Screening and Why Does It Matter to Your Practice?

As someone who is involved with running a healthcare facility or processing billing for one, you may have already heard the term “compliance” used time and again in different contexts. This concept may appear to be a confusing maze of different regulations and rules that must be adhered to at all times. However, there is an important component associated with compliance that needs to be at the top of your priority list: OIG Screening or Office of Inspector General screening.

While OIG screening may sound like a complicated technical process, it is actually very straightforward. Understanding this process will save you and your practice from having to deal with large financial penalties and potential legal issues later down the road.

What is the OIG? The OIG stands for the Office of Inspector General. The OIG acts as a watchdog for the Department of Health and Human Services (DHHS) and helps to prevent and eliminate fraud, waste, and abuse committed by individuals or entities engaged in the delivery of care to patients receiving benefits under the federal healthcare programs such as Medicare and Medicaid.

When an individual and business entity commits fraud, waste, or abuse against one of these federal healthcare programs, the OIG will place that individual and business entity on an exclusion list. The exclusion list is referred to as the List of Excluded Individuals and Entities (LEIE). The exclusion list is similar in function to the No-Fly List; thus, anyone who appears on the LEIE cannot receive any reimbursement from any of the federal healthcare programs, including Medicare and Medicaid.

How Exclusion Screening Works

Exclusion screening involves verifying that your employees, physicians, and suppliers are not identified in the "No-Fly List".

The Risk Involved With Being "On The List"

If you have any employees that are on the exclusion list (even if they are just someone answering the phones or cleaning the building), and they have any involvement with a service that bills to Medicare, you are committing fraud. In short, if there was a service billed to Medicare, and there was an excluded worker in any capacity (ex. cleaning up the office or taking phone calls), you can be forced to repay all of the money you received from Medicare.

The reason you cannot just check once is that there are people who are added to the exclusion list every day. For example, a nurse could have their license revoked or be convicted of a crime in another state, and suddenly they are on the exclusion list.

This means that you must check regularly to stay out of trouble! The majority of people who provide guidance on this issue recommend checking every month. While this may seem like an enormous amount of paperwork, modern technology can make this a simple process.

The Objective of Following the OIG’s Guidelines is to help ward off bad actors by having a solid process for screening people you hire and contracting with to create or maintain the trust of patients in your community. A good process means you have made a commitment to your patients and the Government about providing safe and ethical care.

Start Now! The fear of being out of compliance shouldn’t stop you from getting started with verifying that each person you pay, employees, contractors, and vendors, has been vetted against the OIG database. Checking against the OIG database is an easy step to take that protects your business. If you can’t do this manually and need assistance there are affordable services which will provide you with the support required to complete this step on an ongoing basis.

To ensure your practice and the care you provide is free from harm, believe firmly in the adage that an ounce of prevention is worth a pound of cure, and do not put off establishing your process for screening people.

Read more: https://sportivo.network/blogs/82355/Don-t-Forget-Your-Vendors-The-Hidden-Risks-in-Your