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Everyone wants to be included, right?

It’s not always a good thing. You definitely DON’T want to be a part of THIS exclusive club: Office of the Inspector General, List of Excluded Individuals/ Entities

“OIG has the authority to exclude individuals and entities from Federally funded health care programs and maintains a list of all currently excluded individuals and entities.  Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties…to avoid liability, health care entities need to routinely check the LEIE to ensure that new hires and current employees are not on the excluded list https://exclusions.oig.hhs.gov

“A provider can submit a clean claim but could still be in violation of the False Claims Act if an excluded individual is employed.”

Say what?

If an office office accepts any claims payment through government funding (Medicare, Medicaid, Tricare), they cannot hire or employ any person that is on the LEIE.  It is VERY important that an office check the Exclusions Database on a monthly basis to verify all employees are clear- even the Dentist.  If this is not done and you have hired/ continued to employ someone in the Exclusions Database, you may be subject to civil or monetary penalties.

Why would someone be Excluded from participating?

-health care fraud

-patient abuse/ neglect

-License revocation/ suspension/ surrender

-Default on health education loan or scholarship obligation

-Misdemeanor or Felony controlled substance conviction

The harsh reality:

01-04-2019
Oklahoma Assisted Living Facility Settles Case Involving Excluded Individual:

On January 4, 2019, Baptist Village of Owasso (BVO), Owasso, Oklahoma, entered into a $96,020.92 settlement agreement with OIG. The settlement agreement resolves allegations that BVO employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, an admission specialist, provided items or services to BVO’s patients that were billed to Federal health care programs.

03-08-2019
Oklahoma Skilled Nursing Facility Settles Case Involving Excluded Individual:

On March 8, 2019, Sweet Town, LLC d/b/a Cleveland Manor Nursing and Rehabilitation (Cleveland Manor), Cleveland, Oklahoma, entered into a $171,047 settlement agreement with OIG. The settlement agreement resolved allegations that Cleveland Manor employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, an office manager, provided items or services to Cleveland Manor’s patients that were billed to Federal health care programs.

Avoid situations such as these by keeping up with the Office of the Inspector General, List of Excluded Individuals/ Entities:

Check the list by going here —-> https://exclusions.oig.hhs.gov

Get in Touch

Phone 817-755-0035

email: toothcop@dentalcompliance.com