HHS-OIG Imposes Fines on Healthcare Orgs for Employing Excluded Individuals
An addiction treatment center in Utah and an Ohio nursing center have been forced to pay civil monetary penalties after employing individuals on the Department of Health and Human Services Office of Inspector General (HHS-OIG) exclusion list.
The HHS-OIG exclusion list is a database of organizations and individuals who have been prohibited from participating in federal health care programs. Organizations and individuals are added to the HHS-OIG’s List of Excluded Individuals and Entities (LEIE) when exclusion is mandated by law, such as when an individual has been convicted of Medicare/Medicaid fraud or patient abuse/neglect. HHS-OIG has discretion to exclude individuals and entities on a variety of grounds, termed permissive exclusions, such as for a fraud conviction in a non-health care program or for misdemeanor convictions related to health care fraud.
Healthcare providers are prohibited from purchasing goods and services from entities on the exclusion list, and are not permitted to employ or contract with individuals or entities on the exclusion list. Prior to obtaining goods or services from a new vendor or employing an individual, an HHS-OIG exclusion check should be performed, as fines and damages can be imposed and a violation could result in addition to the exclusion list and exclusion from federal health care programs.
Recently, HHS-OIG determined that Action Recovery Group, an Ogden, Utah-based addiction treatment center, employed an operations assistant on the HHS-OIG exclusion list and provided items or services that were billed to federal health care programs. HHS-OIG and Action Recovery Group agreed to a settlement that involved a civil monetary penalty of $73,457.42.
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Walnut Creek SNF Opco, LLC dba Walnut Creek Nursing Center in Dayton, Ohio, was also found to have employed an excluded individual, a licensed practical nurse, and provided items or services that were billed to federal health care programs. A settlement was agreed that involved a civil monetary penalty of $243,000.
