Joseph Jefferson Jackson, nicknamed "Shoeless Joe," was an American League outfielder who played Major League Baseball in the early 1900s. In 1919, Jackson and the heavily favored Chicago White Sox found themselves back in the running for another World Series victory. However, it was not to be. The following year Jackson was suspended after allegations that eight members of the White Sox threw the previous World Series. In 1921, a Chicago jury acquitted Jackson of helping fix the 1919 World Series, but Kennesaw Mountain Landis, the first commissioner of baseball, went against the ruling and banned all eight players, including Joe Jackson, from baseball for life.
A provider must screen employees and contractors against its state exclusion database as well. The OIG advises providers to check the LEIE monthly to minimize the risk of civil money penalties (CMPs) liability.
In healthcare, the Office of the Inspector General (OIG) has the authority to exclude from participation in Medicare, Medicaid and other Federal healthcare programs individuals and entities who have engaged in fraud or abuse. Additionally, the OIG can impose civil money penalties (CMPs) for certain misconduct related to federal healthcare programs. The effect of an OIG exclusion from federal healthcare programs is that no federal healthcare program payment may be made for any items or services furnished by an excluded individual or entity, or directed or prescribed by an excluded physician (42 CFR 1001.1901).
Healthcare providers that violate this provision risk imposition of civil monetary penalties ("CMPs") of up to $10,000 for each item or service furnished by the excluded person, as well as an assessment of up to three times the amount claimed. In serious cases, the provider itself could face exclusion. The prohibition against federal program payment for items or services furnished by excluded individuals or entities also extends to payment for administrative and management services not directly related to patient care, but that are a necessary component of providing items and services to federal program beneficiaries.
So, all healthcare providers must consider the many legal and ethical factors when hiring employees and contractors. One of the most important of these is compliance with the Office of the Inspector General’s exclusion guidelines. Therefore, it is imperative that all healthcare organizations and providers review the List of Excluded Individuals/Entities (LEIE), which is a list of people who are prohibited from claiming payment from any federal health programs, including both Medicare and Medicaid. Additionally, a provider must screen employees and contractors against its state exclusion database as well. The OIG advises providers to check the LEIE monthly to minimize the risk of CMP liability. While the OIG is not requiring monthly checks, providers that conduct monthly checks may be in a better position to defend situations in which excluded persons are discovered.
Organizations that hire excluded individuals or contractors and bill federal and/or state programs are low hanging fruit for both the OIG and qui tam relators. Be careful not to hire Dr. Joe, and find yourself saying “Say It Ain’t So Joe.”
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