If you don’t check federal and state exclusion lists, you may not be able to keep the payment checks!
The Office of Inspector General for the U.S. Department of Health and Human Services (HHS) is required by law to exclude individuals and entities from Medicaid, Medicare and all other Federal Health programs if they are convicted of certain criminal offenses including Medicare or Medicaid fraud, patient abuse or neglect and certain felony convictions. In addition, the state HHS can exclude any person or entity from participation in their Medicaid program.
Any entity that hires or contracts with a person on the List of Excluded Individuals and Entities is subject to civil monetary penalties and criminal sanctions. The penalties are in addition to the return of any money paid by federal payers in which the excluded individual furnished, prescribed or directed services. Providers are subject to audits and recoupment of any Federal funds paid for those services. To avoid these penalties, providers should:
- Check the Federal Exclusion Database upon hire and annually for all employees, owners, managers and providers in their practice
- Louisiana Medicaid providers must check the Louisiana State Adverse Actions List upon hire and monthly for all employees, owners, managers and providers in their practice
- Arkansas Medicaid providers must check the Excluded Provider List upon hire and periodically thereafter
Providers should document their inquiries and maintain the documentation for audit or future reference. If you or your organization is audited by Medicare or Medicaid, the Medefense™ Plus/Cyber Liability endorsement on your LAMMICO policy may provide coverage to assist with regulatory fines, penalties and audit expenses (subject to the terms and conditions of your policy). For more information, please contact the LAMMICO Risk Management & Patient Safety Department at 504.841.5211.
This is not legal or financial advice, and is not intended to substitute for individualized business or financial judgment. It does not dictate exclusive methods, and is not applicable to all circumstances.