New HHS-OIG Exclusions
The Department of Health and Human Services Office of Inspector General (HHS-OIG) has announced new additions to its List of Excluded Individuals and Entities (LEIE). The LEIE, often referred to as the HHS-OIG exclusion list, is a centralized registry for individuals and entities that have been prohibited from participating in federally funded healthcare programs, including Medicare and state healthcare programs.
There are mandatory exclusions for individuals and entities convicted of criminal offenses such as Medicare or Medicaid fraud, patient abuse or neglect, and for felony convictions for other health care-related fraud, theft, or other financial misconduct, and felony convictions related to the unlawful manufacture, distribution, prescription, and dispensing of controlled substances. HHS-OIG also has the authority to exclude individuals and entities on other grounds, termed permissible inclusions. Reasons for permissive inclusions include misdemeanor convictions, engaging in unlawful kickbacks, suspension or revocation of a healthcare license, and defaulting on health education loans or scholarship obligations.
If an excluded individual or entity continues to work in the healthcare industry and participates in a federally funded healthcare program, they can face criminal prosecution, fines, permanent loss of licensure, or disbarment. An employer can face substantial civil monetary penalties, triple damages for all items and services claimed in connection with that individual or entity, and potentially loss of all federal funding or costly and highly intrusive ongoing monitoring by HHS-OIG.
Each healthcare entity is responsible for ensuring that no new hires or existing employees are excluded. The LEIE must be checked prior to any hire, and routine checks should be conducted to ensure that no current employee has been added to the LEIE.
HHS OIG Exclusions List
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The following entities and individuals have recently been added to the LEIE:
Myers Southern – Myers Southern, LLC, of Bartow, Florida, was excluded for a period of 7 years from participation in federally funded health care programs for failing to respond to an HHS-OIG subpoena that was necessary to determine whether Medicare payments were due, and the amounts associated with those payments.
Dr. Nathan Hanflink and Pain Management Institute – Dr. Nathan Hanflink and Pain Management Institute in Florida, have been excluded from participation in federally funded healthcare programs for 5 years following an HHS-OIG investigation that determined they submitted claims to Medicare Part B for chronic care management services that were never rendered.
Sunshine Care Partners and Rusty McMurray – Sunshine Care Partners, and owner Rusty McMurray have been excluded from participation in healthcare programs for 10 years after knowingly submitting claims for complex chronic care management services for individuals who were never provided with those services. According to HHS-OIG, those complex care management services only involved having employees take the temperature of all individuals entering the facility, sanitizing and cleaning front desk areas, and organizing paperwork.
