The U.S. Department of Health and Human Services, Office of the Inspector General (OIG) may exclude individuals and entities from federally funded healthcare programs under 42 U.S.C. §§ 1320a-7 and 1320c-5. By law, the OIG must exclude individuals and entities for convictions of select criminal offenses. The OIG has updated the criteria for exclusion, which CG attorneys previously discussed. Generally, no federal healthcare program payment will be made for items or services furnished, ordered, or prescribed by or at the direction of an excluded individual or entity. Importantly, providers or companies that employ or contract with excluded individuals to provide services payable by federal healthcare programs may be subject to civil monetary penalties. The OIG issued an Updated Special Advisory Bulletin on the effect of exclusion, which contains additional guidance.
On April 12, 2021, the U.S. Department of Justice issued a press release regarding a settlement agreement entered into by CareCo Medical, a home health organization, and CareCo’s owner (collectively, “CareCo”). The settlement agreement was reached after CareCo employed an individual excluded from federally funded healthcare programs. Between November 2018 and March 2019, CareCo employed Todd Roberts in a management position. In 2012, Roberts pled guilty to obstructing a federal audit. As part of the plea, Roberts agreed to pay approximately $328k and entered into a six-year Integrity Agreement. Roberts was excluded from all federal healthcare programs in 2015 after he breached the Integrity Agreement. Despite employing Roberts for less than six months, CareCo Medical and its owner agreed to collectively pay $28,246.00 to resolve their potential liability for hiring Roberts while he was excluded.
The CareCo settlement is a reminder for employers and individuals that employ or contract with providers to routinely check the names of current and would-be employees/contractors against the OIG exclusion database. Moreover, Roberts’ exclusion demonstrates the long-term implications of enforcement actions against individuals. Companies and individuals subject to government investigations or that are contemplating any agreement with the government should carefully consider the long-term impact of the agreement and should seek legal counsel with experience in government investigations.
The attorneys at Chilivis Grubman represent healthcare providers in connection with all types of fraud and compliance matters, including government investigations, exclusion proceedings, and self-disclosure. If you need assistance with such a matter, please contact us today.