In the first part of our Cover Your Attestation article series, we discussed why insurance companies are asking for Annual Compliance Attestation. We also discussed annual Corporate Compliance training requirements.
In this part, we will discuss FDRs (first-tier, downstream, and related entities) requirement for checking exclusion lists.
Medicare Advantage plan sponsors are required to ensure that all FDRs are screening all employees/vendors/subcontractors against the DHHS OIG List of Excluded Individuals and Entities (LEIE) prior to hiring or contracting and then re-check monthly thereafter.
Yes, you read that right – the exclusion list is required to be checked on a monthly basis.
This means that your organization is responsible for not employing or contracting with excluded individuals or entities, whether in a physician practice, a clinic, or in any capacity or setting in which Federal healthcare programs may reimburse for the items or services furnished by those employees or contractors. This responsibility requires screening (prior to hiring or contracting and monthly thereafter) all current and prospective employees and contractors against OIG’s LEIE.
The OIG Exclusion list may be accessed by clicking here.
Why check for excluded individuals and entities?
According to the OIG, an excluded person violates the exclusion if the person furnishes to Federal health care program beneficiaries items or services for which Federal health care program payment is sought. In other words, an excluded person that submits a payment to a Federal health care program, or causes such a claim to be submitted, may be subject to a civil monetary penalty (CMP) of $10,000 for each claimed item or service furnished during the period that the person was excluded. In addition, you may be subject to an assessment of up to three times the amount claimed for each item or service, and denial of reinstatement by OIG to Federal health care programs because of an exclusion violation.