Home Health and Nursing Home Facilities a Major Target for OIG Enforcement

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civil monetary penalties

I.  Civil Monetary Penalties

Twenty-five out of the fifty-five exclusion enforcement actions reported in 2014 have occurred in home health, hospice, or nursing and rehabilitation facilities. The Civil Monetary Penalties (CMPs) imposed in these cases range from $10,000 to $428,935 for employing just one individual that the employer knew or should have known was excluded from participating in the Federal health care programs. Providers are reminded that the Office of the Inspector General (OIG) recommends screening employees and vendors before hiring or contracting with them, and to continue screening on a monthly basis.

One reason why some providers were liable for much higher CMPs is due to the amount of time the provider employed or contracted with the excluded individual before disclosing the violation to OIG. The government cannot pay for any services provided directly or indirectly by an excluded person. Therefore, the entire amount must be repaid back to the government.[1] This amount is typically subject to a minimum multiplier of 1.5 times the total amount paid by the Federal health care programs.[2] For that reason, the longer you employ a person without realizing they are excluded, the more you will be liable to pay back to the Federal health care programs.

Here is a list of enforcement actions against home health, hospice and nursing facilities in 2014:
2014 OIG Enforcement Action

You can view the entire list on the OIG’s Enforcement Action Page here.  

II.  Home Health Agencies Vulnerable to Fraud

OIG conducted a study in late 2012 that focused specifically on home health agencies.[3] The report found that Medicare paid home health agencies that had been suspended or had their billing privileges revoked. The report concluded that home health agencies are particularly vulnerable to fraud, waste, and abuse. It also recommended that CMS establish additional standards and systems to ensure that improper payments are not being made to suspended individuals.

Read the full report here.

Two-thirds of the CMPs imposed in 2014 were towards providers who self-disclosed that they had employed an excluded individual. Many of those CMPs could have been avoided easily by frequent screening. Providers should be aware and take care to screen all employees and vendors monthly for excluded individuals. Employing just one excluded person has serious repercussions.

If you have concerns about your organization’s screening, contact us at Exclusion Screening, LLCSM by calling 1-800-294-0952 or filling out the form below.  



Ashley Hudson 

Ashley Hudson, Associate Attorney at Liles Parker, LLP and former Chief Operating Officer for Exclusion Screening, LLC, is the author of this article. 

 [1] Dep’t of Health and Human Servs. Office of the Inspector Gen., Updated OIG’s Provider Self-Disclosure Protocol, 10 (Apr. 17, 2013).

[2] Dep’t of Health and Human Servs. Office of the Inspector Gen. at 14.

[3] U.S. Dep’t of Health and Human Servs. Office of the Inspector Gen., CMS and Contractor Oversight of Home Health Agencies 17-19 (Dec. 2012).

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