Check the OIG Exclusions Database! Doing Business With Excluded Individuals or Entities Can Lead to Substantial Liability
In January 2015, an Alabama hospital paid nearly half a million dollars in civil monetary penalties (“CMPs”) after self-disclosing the employment of an individual who had been excluded from participation in Federal healthcare programs. Nine days later, another Alabama hospital paid over $100,000 for employing an excluded individual, whom the Department of Health & Human Services, Office of Inspector General (“OIG”) identified through a data analysis project initiated by the OIG’s Office of Evaluation and Inspections. Since January 1, 2015, several other healthcare providers, including a group home and a pharmacist, have also agreed to pay substantial CMPs for similar conduct.
The CMP law prohibits, among other things, arranging or contracting (by employment or otherwise) “with an individual or entity that the person knows or should know is excluded from participation in a Federal healthcare program . . . for the provision of items or services for which payment may be made under such a program.” This means that a healthcare provider may be liable for CMPs if that provider hires, or in any other way arranges or contracts with, an excluded individual to provide items or services. OIG can impose a penalty of up to $10,000 for each item or service provided in violation of this rule, plus an assessment of three times the amount claimed for such item or service. Moreover, a provider that violates this rule risks its own exclusion from participation in Federal healthcare programs, and faces liability under the False Claims Act. Importantly, the provider need not have had actual knowledge that the individual or entity in question was excluded in order to face liability. Instead, the provider may be liable if it “should have known” (i.e., it acted with reckless disregard or in deliberate ignorance) of the exclusion.
Providers should search the exclusions database on OIG’s website (http://exclusions.oig.hhs.gov/) in order to ensure that the individuals and entities with which they do business are not excluded. Best practices dictate performing a search of the exclusions database as early as possible during the hiring and/or contracting period. Failure to do so could lead to serious and lasting consequences.
For more information, please contact attorney Scott Grubman at (404) 262-6505 or sgrubman@cglawfirm.com.
To speak to an attorney at the firm about your healthcare law case, contact us online or by calling (404) 233-4171.