2015 Mid-Year Exclusion Enforcement Action Review

OIG Exclusion EnforcementOIG has been busy cracking down on providers who employ or contract with excluded persons or contractors.  In fact, by the end of July OIG settled 27 exclusion violation cases through investigations or self-disclosures.  By way of reminder, there were 60 enforcement actions related to OIG exclusion violations in 2014.  Following is our 2015 mid-year review of OIG’s enforcement against those who employ or contract with excluded providers.

Civil Monetary Penalties 

 

 

 

 

In six months, OIG recouped $3.79 million from providers who knew or should have known that an employee was excluded from participation in the federal health care programs.  A third of the settlements in the past six months resulted in payments between $100,000 and $250,000 per provider.  The Civil Monetary Penalties (CMPs) returned in each enforcement action range from $10,000 to $431,000 and an overwhelming majority of the cases only involve one excluded individual.  In fact, only 4 of the 27 enforcement actions this year involved more than one excluded provider.  This goes to show that the penalty a provider may face for employing or contracting an excluded person varies widely depending on exactly how many items or services that person provided.

Industry Breakdown

One trend that remains steady is that nursing homes continue to be the industry hit the hardest with enforcement actions.  Following behind nursing homes were hospitals and home health agencies with four enforcement actions each so far this year.  We expect that nursing homes and home health agencies will remain hot beds for OIG exclusion enforcement action as the year progresses.

State Breakdown

One area where 2015 enforcement actions depart from 2014 is the states in which OIG has imposed CMP liability. Texas and California were still hit hard, but Minnesota actually surpassed California with three enforcement actions in the first half of 2015.  Virginia has also been under OIG’s microscope, with three enforcement action settlements this year, making quite the jump from just one in 2014.  We have also seen enforcement action in states that did not have any issues in 2014 like Alabama, Illinois, Indiana, Maryland, and Washington.

Takeaway

While we try to draw comparisons to shed light on OIG’s exclusion enforcement action focus, the fact of the matter is that OIG exclusion enforcement is here to stay.  Nursing homes continue to be a target and the cost of employing just one excluded individual is hefty.  The risks associated with failing to properly screen your employees and contractors is far too high and drastically outweighs the cost of properly screening against all available State and Federal lists monthly.  Contact Exclusion Screening, LLCSM today for a free consultation at 1-800-294-0952 or fill out our online service form.

Also read more on OIG Exclusion