As outlined in the Code of Federal Regulations, the OIG may exclude an individual from participation in federal and state health care programs for a variety of offenses. Mandatory and permissive exclusions are as follows:
Mandatory Exclusions (no less than 5 years)
Permissive Exclusions (period varies according to nature of offense)
Federal and state regulations/guidances indicate that health care institutions are expected to perform sanction screenings for their employees, both current and new hires. Any vendor organizations or contractors (e.g., referring physicians) that provide services to the health care institutions must also be screened, not only for exclusion of those entities, but for exclusion of any individual employees working for them. As stated in multiple places in the regulations, the OIG has the ability to sanction an individual on the basis of whether the person “knows or should know” of the actions constituting the basis for the exclusion. In October 2010, the OIG released a “Guidance for Implementing Permissive Exclusion Authority Under Section 1128(b)(15) of the Social Security Act”, giving OIG the authority to exclude an officer or managing employee of an entity that has been excluded or has been convicted of certain offenses. Click here to review the details.
To support health care organizations in their compliance efforts, various federal and state organizations provide online, searchable databases and updated database downloads, including:
There are various risks/challenges to be considered when creating a sanction screening program.
E-mail Address:
OIG Compliance NOW, LLC
49 Court Street
Binghamton, NY 13901
Phone: (607) 240-2400
Fax: (607) 722-1877
E-mail: info@oigcompliancenow.com
OIG COMPLIANCE NOW, LLC is a Limited Liability Corporation and is not affiliated with the United States Federal Government in any way. OIG COMPLIANCE NOW, LLC is not a government agency, nor is it approved, endorsed or authorized by the Department of Health and Human Services, the Office of Inspector General or with any agency of the federal or any state government to conduct its business.