WHAT IS THE EXCLUDED PROVIDER LIST AND WHO IS ON IT?
Bases for exclusion can
include convictions for program-related fraud and patient abuse, licensing board
actions, license revocation / suspension / surrender and default on Health Education
Currently, the Office of the Inspector General of the U.S. Department of Human Services
(OIG) and the New York State Office of the Medicaid Inspector General (OMIG) maintain
over 50,000 records combined for excluded providers, and the numbers are growing
WHY DOES OUR ORGANIZATION HAVE TO DO THIS?
Matching your employees
against these lists is a Federal and State mandate.
In fact, every healthcare provider in the country is required to do it.
Recently, in a letter to State Medicaid Directors, Herb B. Kuhn, Deputy Administrator
and Acting Director for the Center for Medicaid and State Operations stated, “States
should require providers to search the HHS-OIG website monthly to capture exclusions
and reinstatements that have occurred since the last search.”
WHAT HAPPENS IF OUR ORGANIZATION DOESN’T DO IT?
Penalties can be applied if a provider knowingly employs or contracts with an excluded
individual or entity to provide services or items for which payment is sought under
any federal health care program. These
penalties include civil monetary penalties of up to $10,000 per service, an assessment
of up to three times the amounts paid for the services, and even exclusion from
the federal health care programs.