2014 In Review – OIG Crack Down on Exclusion Violations

I.  CMPs doubled in OIG Exclusion Violations 2014

Exclusion Screening, LLC^SM dedicates a significant amount of time to examining the Office of the Inspector General’s (OIG) enforcement actions as they relate to exclusion violations. As a broad overview, in 2014 HHS-OIG imposed $10.54 million in Civil Monetary Penalties (CMPs) on providers that “knew or should have known” one or more of their employees or vendors was excluded from participation in the Federal health care programs. Most noteworthy, this number more than triples the $3.26 million in CMPs collected in 2013 and is the highest amount collected in the last five years.

In 2014, the OIG cracked down on many different types of providers. The OIG’s focus varied from pediatricians to large hospitals to home health organizations. However, the OIG specifically targeted nursing homes, which totaled a quarter of all exclusion enforcement actions in 2014. While nursing homes were also the most highly targeted industry in 2013, the OIG doubled the number of enforcement actions against nursing homes for exclusion violations in 2014.

II.  2015 Likely to See Increase in OIG Enforcement Action

Do these higher CMP amounts and increased enforcement actions mean there were simply more bad actors in 2014 than 2013? Likely no. These increases indicate that the OIG has identified an area ripe with exclusion violations and chose to target this sector. In fact, in its 2015 Work Plan, the OIG specifically mentions that fraud is prevalent in home health agencies and pledged to determine the extent to which home health agencies are employing individuals with “potentially disqualifying” criminal convictions. 

Are specific areas of the United States more vulnerable than others for exclusion related violations? No. In fact, the OIG enforcement actions are not localized to one particular state or geographic area. The 60 exclusion enforcement actions in 2014 spanned 32 states. Texas took the lead with 6, and California followed closely with 5. Utah, North Carolina, and Ohio each had 4 enforcement actions. Furthermore, smaller states like Vermont and Iowa were not far behind with 3 and 2 enforcement actions.

III.  Monthly OIG Exclusion Screening Is Essential

From this data, we can conclude that no matter the size, location, or industry, providers and health care organizations must be checking all their employees and vendors for exclusions against the LEIE, SAM, and state lists monthly. The OIG is not slowing down enforcement of exclusion violations. The OIG posted its first exclusion action of 2015 with a CMP collection of $431,041.28 for one excluded employee. Conducting proper screening may seem burdensome, but Exclusion Screening, LLC^SM can help your practice comply with state and federal exclusion screening obligations at a low, fixed price. Contact us for a free consultation at 1-800-294-0952 or fill out our online service form, found below, today.

Read more about OIG Exclusions by clicking here!

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