Re: {Healthcare Technology Alliance}, Re: Free access to the OIG Excluded list

[Raj Nukala]

Alan

That is a great response. Said there is considerable risk involved. How is the risk mitigated? In the case of Medicaid/Medicare claims - Does it make sense for an organization to use a third party which is not a direct beneficiary of the transaction to conduct the lookups and provide a full audit trail of such lookups ? As the third party will not be the direct beneficiary , claim beneficiary has demonstrated significant risk mitigation and could avoid heavy penalties and it is not in the interest of the third party to falsely identify some one as being or not being on the list as they are not the direct beneficiaries of a claim - You know what I mean ..

Regards
Raj

----- Original Message ----
From: "snuf...@aol.com" <snuf...@aol.com>
To: techal...@googlegroups.com
Sent: Tuesday, April 8, 2008 11:29:37 AM
Subject: {Healthcare Technology Alliance}, Re: Free access to the OIG Excluded list

Marshall,

My suggestion is that unless your healthcare entity has a dedicated qualified staff person checking the excluded list daily, the risk to the healthcare entity is very costly if they get caught with some of these excluded people doing work with or for them as seen per regs below:

Per the regs: An excluded party is in violation of its exclusion if it furnishes to Federal program beneficiaries items or services for which Federal health care program payment is sought. An excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a CMP of $10,000 for each item or service furnished during the period that the person or entity was excluded (section 1128A(a)(1)(D) of the Act). The individual or entity may also be subject to treble damages for the amount claimed for each item or service. In addition, since reinstatement into the programs is not automatic, the excluded individual may jeopardize future reinstatement into Federal health care programs (42 CFR 1001.3002).

Finally your assumption with regard to employees not being able to hide their being on a the excluded list from their employing organization assumes that they never work a second job within healthcare.  Additionally, someone also needs to watch all of the vendors doing work with the entity as seen in this statement on the OIG website:

Set forth below is a listing of some of the types of items or services that are reimbursed by Federal health care programs which, when provided by excluded parties, violate an OIG exclusion. These examples also demonstrate the kinds of items and services that excluded parties may be furnishing which will subject their employer or contractor to possible CMP ("civil money penalty") liability.

• Services performed by excluded nurses, technicians or other excluded individuals who work for a hospital, nursing home, home health agency or physician practice, where such services are related to administrative duties, preparation of surgical trays or review of treatment plans if such services are reimbursed directly or indirectly (such as through a PPS or a bundled payment) by a Federal health care program, even if the individuals do not furnish direct care to Federal program beneficiaries;

• Services performed by excluded pharmacists or other excluded individuals who input prescription information for pharmacy billing or who are involved in any way in filling prescriptions for drugs reimbursed, directly or indirectly, by any Federal health care program;

• Services performed by excluded ambulance drivers, dispatchers and other employees involved in providing transportation reimbursed by a Federal health care program, to hospital patients or nursing home residents;

• Services performed for program beneficiaries by excluded individuals who sell, deliver or refill orders for medical devices or equipment being reimbursed by a Federal health care program;

• Services performed by excluded social workers who are employed by health care entities to provide services to Federal program beneficiaries, and whose services are reimbursed, directly or indirectly, by a Federal health care program;

• Administrative services, including the processing of claims for payment, performed for a Medicare intermediary or carrier, or a Medicaid fiscal agent, by an excluded individual;

• Services performed by an excluded administrator, billing agent, accountant, claims processor or utilization reviewer that are related to and reimbursed, directly or indirectly, by a Federal health care program;

• Items or services provided to a program beneficiary by an excluded individual who works for an entity that has a contractual agreement with, and is paid by, a Federal health care program; and

• Items or equipment sold by an excluded manufacturer or supplier, used in the care or treatment of beneficiaries and reimbursed, directly or indirectly, by a Federal health care program.

By the way, I am not sure about your promo comment since I suggested an automation solution based on Raj's request and on the fact that this is a technology group.  Your solution states that you manually check each person one (or up to five at a time) and then manually print the results and put it in the employee's folder as seen in your email below.

Alan


-----Original Message-----
From: Marshall Maglothin <mmagl...@medaxiom.com>
To: techal...@googlegroups.com
Sent: Mon, 7 Apr 2008 10:30 pm
Subject: {Healthcare Technology Alliance}, Free access to the OIG Excluded list

Well, I suspected this was not an honest inquiry, but some kind of promo.

 

The weblink I provided is the FREE, OFFICAL, U.S.  OIG site:

http://oig.hhs.gov/fraud/exclusions.html

 

 and any large healthcare organization that I have ever encountered simply checks new employees as they hire them.

 

Being "excluded" after being hired is certainly not something that a current employee could hide from the employing organization.

 

 

From: techal...@googlegroups.com [mailto:techal...@googlegroups.com] On Behalf Of snuf...@aol.com
Sent: Monday, April 07, 2008 9:16 PM
To: techal...@googlegroups.com
Subject: {Healthcare Technology Alliance}, Re: OIG and Integration

 

I am aware of a company that for a fee has automated and will undertake a review process of those vendors, new employees, current employees, doctors, etc. that may be on this list if anyone is interested.

Regards,

Alan


-----Original Message-----
From: Marshall Maglothin <mmagl...@medaxiom.com>
To: techal...@googlegroups.com
Cc: rajn...@yahoo.com
Sent: Sun, 6 Apr 2008 11:41 am
Subject: {Healthcare Technology Alliance}, Re: OIG and Integration

In the U.S., all healthcare providers who do business with DHHS CMS, that is

bill for services to Medicare, Medicaid, Tricare, Retired Railroad, etc or

as you noted are engaged in research that receives any Federal funding, are

required to verify that ALL employees (physicians, RNs, clerks, dietary

aides: ALL) are not on the OIG excluded list.

http://oig.hhs.gov/fraud/exclusions.html

This is fairly fool-proof for physicians since they not only have to be

checked by their malpractice insurer, but are also "credentialed" by each

hospital and every insurance plan -all of whom are required to check the

list and, by contract, and report any excluded provider to the other

parties.  All insurance companies' contracts require that they immediately

drop (not pay) any excluded physician.

For all other employees, the process is very simple: at the time of

employment, the person's name is checked against the OIG list which can

either be downloaded or checked on-line:  http://exclusions.oig.hhs.gov/

I print a copy of my search for the name when it returns "not found" and

drop it in the new employee's personnel file for compliance documentation. 

-----Original Message-----

From: techal...@googlegroups.com [mailto:techal...@googlegroups.com]

On Behalf Of Raj Nukala

Sent: Friday, April 04, 2008 12:13 PM

To: techal...@googlegroups.com

Subject: {Healthcare Technology Alliance}, OIG and Integration

Hello All 

I am interested to know how present day hospitals are using or integrating

OIG compliance check. Any companies performing clinical trials are also

using OIG Exclusion to not do business with any one on this list ?

Appreciate if anyone can share with me the scenarios which call for OIG

exclusion list check.

Regards

Raj

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[William A. Bowen]

This link below may be an additional resource for you for all additional information that will not be on the OIG Excluded list. There are fees, but I found that they do their services at a much lower cost than most organizations and are less costly than trying to do background checks in-house on a case by case basis. This information is auditable and can be customized to your needs.  

 

http://www.americandatabank.com/healthcare.asp

 

Setting up a proper code of conduct signed by all employees and creating a very visible/solid vendor selection process should be the first step in dealing with hiring on vendors or contractors. Depending on the size of your organization extremely departmentalizing the vendor process, putting internal audit on as a monitoring group and vetting each contract in a very standard process (possibly involving an outside legal party) will mitigate your risk

 

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