A dental practice agreed to pay $279,135 as part of a settlement agreement after allegedly employing an individual whom the dental practice knew or should have known was excluded from participation in federal healthcare programs, according to the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services (HHS). According to the report, the dental practice self-disclosed the alleged violation to the OIG. A simple check of the OIG’s List of Excluded Individuals and Entities (“LEIE”) of the HHS website likely would have saved the practice that money.
Employing an excluded individual may subject a dental practice to payment prohibitions and civil monetary penalties. With limited exceptions, no payment will be made by any federal health care program for any items or services furnished, ordered or prescribed by an excluded individual or entity, and no federal healthcare program payment will be made for anything that an excluded person furnishes, orders, or prescribes. The payment prohibition applies not only to the excluded person, but also to anyone who employs or contracts with the excluded person, any other healthcare provider for which the excluded person provides services, and anyone else. The exclusion applies regardless of who submits the claim, and applies to all administrative and management services furnished by the excluded person.
In addition, the OIG has the authority to seek civil monetary penalties against an individual or entity based on a wide variety of prohibited conduct, such as employing or contracting with an excluded individual.
A dental practice can help manage the legal risk by checking to see whether an individual is excluded prior to hiring, and periodically thereafter. The OIG updates the LEIE website monthly, so it’s a good idea to visit on a regular basis to catch any changes. Additionally, a dental practice may choose to subscribe to email updates from OIG concerning the LEIE. The Department of Health and Human Services also offers a five-minute video explaining how to search its list of excluded individuals and entities.
If a dental practice checks the LEIE for the name of a prospective hire and finds an apparent match, the dental practice may wish to verify that the individual listed is the same person as the prospective hire. In the event of a positive match, the OIG advises checking the Special Advisory Bulletin on the Effect of an Exclusion for guidance.
If a dental practice discovers that it has already employed an excluded individual, the OIG suggests checking the OIG’s Self-Disclosure Protocol. A dental practice may wish to consult legal counsel prior to self-disclosure.
OIG has the authority to exclude individuals and entities from participation in federal healthcare programs such as Medicare and Medicaid. In some cases, exclusion is mandatory, such as if an individual is convicted of a crime related to federal healthcare programs or patient abuse and neglect. In other cases exclusion is permissive, such as a misdemeanor conviction relating to health care fraud or a controlled substance.
Keep in mind that states may also maintain their own individual exclusions lists. State law may require a dental practice to check this list, or other databases on a periodic basis. Checking with your state dental society is a good place to start in determining if this is a need.
Do you need more information about exclusions and the LEIE? The OIG has a Frequently Asked Questions page on this topic. Or watch this short video on How to use the LEIE Online and Downloadable Databases.