Hiring an Excluded Individual – Employer Beware!

by admin on November 13, 2019 No comments

hiring an excluded individualBy: Dave Davidson

It’s probably fair to say that most healthcare providers are aware of the federal Anti-Kickback Statute and the Stark Law (and if you’re not, please call me immediately!).  Those two laws, along with the False Claims Act, are the sources of the huge fines and penalties that make the headlines for governmentally discovered “fraud.”  However, there are a number of other regulatory provisions out there that the Office of Inspector General (OIG) is regularly policing.

One of these laws, with its origins in the Social Security Act, is the prohibition against providers hiring individuals or entities who have been excluded from participation in governmental health care programs such as Medicare or Medicaid.  Hiring an excluded person or company can expose a provider/employer to Civil Monetary Penalties, which can result in significant financial hardship to the provider.  And although this may seem like a simple rule to follow, recent enforcement activity shows that it may be fairly easy for an excluded person to “fall through the cracks” and wind up as your employee.

For example, within the last six months, the OIG has settled 11 claims brought against providers for hiring an excluded individual.  The penalties imposed for these violations ranged from $10,000 to over $125,000.  The subject providers ranged from large hospitals to single providers, and the excluded individuals filled both clinical and administrative roles.

This recent activity highlights the importance of screening your potential new hires and regularly checking your employee roster against the OIG’s List of Excluded Individuals/Entities found HERE.  Otherwise, you could find yourself the subject of federal enforcement.  Caveat Dico – employer beware!

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