I. OIG Recommends Monthly Screening
While there is not a formal regulation that mandates monthly exclusion screening, OIG issued guidance in May 2013, which recommended that providers check their employees and contractors against the OIG-LEIE each month because the LEIE is updated on a monthly basis. Just how many new names could possibly be added to the LEIE each month? According to Modern Healthcare, OIG adds approximately 300 new names to the LEIE every month.[1] Providers are reminded that if OIG discovers that a provider billed for items or services provided by an excluded individual, it may impose CMPs up to $10,000 for each item or service billed to the Federal health care programs. So, while it is not necessarily mandatory at the Federal level, monthly screening is in every provider’s best interest, especially with such a large number of names being added to the LEIE each month.
II. 14 States Require Monthly Screening
Furthermore, monthly screening IS mandatory in at least fourteen states, while many others strongly suggest providers screen employees and vendors against their state list and the LEIE monthly.
For example, Hawaii states on its Medicaid website that any provider who participates in the Medicaid program must search Hawaii’s excluded provider list monthly and the LEIE on an annual basis to determine whether an employee or contractor has been excluded from participation in the Medicaid program. Kentucky mandates monthly screening against Kentucky’s state Medicaid list, the OIG-LEIE, and the GSA-SAM.[2] New Jersey made exclusion searches mandatory in 2010.[3] New Jersey providers and HMOs are responsible for verifying all “current and prospective employees (regular or temporary), contractors or subcontractors who directly or indirectly will be furnishing, ordering, directing, managing or prescribing items or services in whole or in part are not excluded, unlicensed or uncertified by searching the following databases on a monthly basis:” OIG-LEIE, NJ Treasurer’s Exclusions Database, NJ Division of Consumer Affairs licensure database, NJ Department of Health and Senior Services licensure database, Certified Nurse aide and personal care assistant registry, and National Provider Database (NPDB).
Providers are reminded that if you are a provider in North Carolina and one of your employees is on Hawaii’s excluded provider list, then you have violated the exclusion provisions. Under ACA Section 6501, an individual or entity that is excluded from one state’s Medicaid program is excluded in all states. So, yes providers really do need to conduct exclusion screening checks of the LEIE, GSA-SAM, and all 38 state lists on a monthly basis.
Feel free to contact the exclusion experts at Exclusion ScreeningSM at 1-800-294-0952 or fill out the form below for a free consultation.
[1] Joe Carlson, Exclusion Efforts – OIG Pushes for monthly blacklist cross-check, Modern Healthcare (May 18, 2013, 12:01 AM). http://www.modernhealthcare.com/article/20130518/MAGAZINE/305189975/exclusion-efforts?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGJVZndKRWxYOU9qTENvK25lK0g4UktiMnBlMDVva2d3YytteWJHZUU0akNYWm85ZStYYzJoUkE9PQ==.
[2] KY Medicaid Program Terminated and Excluded Provider List, KY Cabinet for Health and Family Servs. Dep’t for Medicaid Servs. http://www.chfs.ky.gov/dms/term.htm (last accessed July 21, 2014).
[3] Newsletter to All Providers and All Health Maintenance Organizations from the NJ Dep’t of Human Servs., 20 Excluded, Unlicensed or Uncertified Individuals or Entities (Oct. 2010).