Find out how healthcare sanctions checks conducted during the screening and hiring process can help you manage risk in your healthcare organization.
Healthcare organizations regularly search the Health and Human Services Office of Inspector General (OIG) exclusion list as part of pre-employment and routine employee background screening to enable informed decisions and maintain good standing with federal programs like Medicare and Medicaid. In this article, learn how conducting OIG background checks can help you maintain optimal patient safety and professional standards.
In the healthcare industry, employers must conduct in-depth hiring and screening processes that go beyond criminal background checks and drug tests on job candidates. Whether you’re seeking to hire physicians, nurses, or other healthcare positions, you may also consider conducting an OIG background check as part of your national background check program. Healthcare sanctions screenings, which includes an OIG background check, help employers maintain eligibility for federal healthcare programs, avoid penalties, protect patient care standards, and reduce the risk of fraud and reputational damage.
What Is The OIG Exclusion List?
The OIG exclusion list, formally known as the List of Excluded Individuals/Entities (LEIE), is a nationwide database of sanctioned individuals and organizations maintained by the Office of Inspector General as part of its oversight of Medicare, Medicaid, and other federal health programs. Individuals and organizations on the list are excluded from participating in these federally-funded programs, as are the organizations that employ them.
Contractors and healthcare providers may be added to the OIG exclusion list for several different reasons, including convictions for healthcare-related fraud (including Medicare or Medicaid fraud), convictions related to the manufacture or dispensing of controlled substances, and patient abuse or neglect.
Searching the OIG exclusion list is critical to healthcare employers. Hiring a candidate who is on the exclusion list may subject an organization to civil monetary penalties of up to $10,000 per day of employment for every excluded, employed individual. It may also disqualify an organization from participating in federally funded healthcare programs such as Medicare and Medicaid.
More generally, conducting an OIG exclusion search and other healthcare sanctions is an important part of an organization’s healthcare risk management strategy. Healthcare is a highly regulated industry for good reason: Healthcare providers serve vulnerable populations and handle large, complex financial transactions. An OIG screening can help healthcare employers make informed hiring decisions to mitigate risk to both patients and business.
What Is An OIG Background Check?
An OIG background check searches the LEIE database to see whether a candidate is excluded from participating in federal and state healthcare programs. Often, employers conduct an OIG check as part of a comprehensive medical and healthcare sanctions screening that may include multiple screening searches across a wide range of government sources.
LEIE exclusions are categorized as either mandatory or permissive. Mandatory exclusions are felonies and may include the following:
- Conviction of Medicare or Medicaid fraud
- Patient abuse or neglect
- Felony convictions for other healthcare-related fraud, theft, or other financial misconduct
- Felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances
Mandatory exclusions remain on the OIG list for five years; 10 years if the individual has received two mandatory exclusions, and permanently if they’ve received three or more mandatory exclusions.
Permissive exclusions are typically misdemeanors. Among the many possible reasons for permissive exclusions include:
- Misdemeanor convictions related to healthcare fraud or controlled substances
- License revocation, suspension, or surrender
- Submission of false or fraudulent claims to a federal healthcare program
- Failure to meet statutory obligations to provide medically necessary services meeting professionally recognized standards of care
The OIG has greater discretion on how long a permissive exclusion remains in the database. Typically, permissive exclusions remain for three years or less.
Many healthcare employers include an OIG background check as part of a larger search of healthcare- and government-related databases. For example, the US government’s System for Award Management (SAM) database maintains a list of contractors who are excluded from working with the government. Forty-two states maintain their own Medicaid exclusion lists, which are separate from the OIG list but may be equally critical. A qualified consumer reporting agency (CRA), like GoodHire, may include state Medicaid, OIG and SAM searches as part of healthcare sanctions screenings that check as many as 1,000 federal and state government sources to ensure a broad scope for healthcare employers conducting background checks.
OIG Check Laws To Know
The OIG maintains the exclusion list as described in Section 1128 and Section 1159 of the Social Security Act. OIG check requirements are more implicit than explicit: The law does not specifically require employers to conduct OIG background checks, but there are consequences for employers who knowingly or unwittingly hire or contract with individuals on the OIG exclusion list. To avoid these consequences, highlighted below, organizations that participate in Medicare, Medicaid, or other federal healthcare programs may choose to conduct routine OIG verification as part of the pre-employment screening process, as well as regularly screening all employees against the OIG exclusion list.
The effects of hiring or continuing to employ an individual on the OIG exclusion list can be severe, including:
- Loss of eligibility for federal funding through Medicare, Medicaid, and other federal healthcare programs
- Being required to return federal funds received from these programs dating back to when the excluded person was hired
- Civil monetary penalties of up to $10,000 per claim
- $10,000 for each day an excluded individual retained a prohibited ownership or control interest in a participating organization
- $10,000 for each claimed item or service furnished during an exclusion period
- Assessments of up to three times the amount claimed for each item or service
- Denial of reinstatement by OIG to federal healthcare programs when an exclusion violation has occurred
Additionally, individuals on the OIG exclusion list may pose a risk to the health and safety of patients, and may represent an increased risk for financial fraud and non-compliance.
Employers may also find it helpful to know that the OIG’s exclusion process includes issuing Notices of Intent to Exclude (NOIs) to individuals who are under consideration for exclusion. A person who has received an NOI may submit materials in their own defense and eventually appeal an exclusion decision to an administrative judge. During this process, the individual may not appear on the OIG exclusion list—and therefore an alert may not be present during a pre-employment screening—only to be added to the list after they’ve been hired. Adding regular OIG screenings for all employees can help protect organizations from unknowingly employing excluded individuals.
How To Run An OIG Exclusion Search
The online searchable database that is free to use. Employers, and individuals, can use the online database to conduct their own OIG exclusion search for up to five candidates at a time by name with verification by Social Security number (SSN) or Employer Identification number (EIN). The LEIE database can also be downloaded, but users may find the interface cumbersome to use. Also, the downloadable version does not include SSNs or EINs, which can make results difficult to verify.
Working with a CRA for healthcare sanctions screenings can simplify the process, as OIG checks are only one type of search employers may wish to conduct. GoodHire, for example, offers four levels of healthcare sanctions coverage, beginning with OIG and SAM searches and expanding to include comprehensive searches of United States government sources. Screening results may verify information that isn’t typically available through the OIG or SAM databases directly, including:
- The violation or reason for exclusion
- Whether it’s currently active (or the end date if the sanction is no longer active)
- The name of the source or board that took the disciplinary action
- The ability to add Ongoing Alerts to be notified if an employee has been recently added to the OIG exclusion list
A trusted CRA, like GoodHire, can also help you navigate employment screening laws that affect disclosure, authorization, and adverse action when conducting any type of background check on prospective or current employees.
Get An OIG Check With GoodHire
Searches of the OIG exclusion list, and other healthcare sanctions checks, are among the hundreds of screening services offered by GoodHire. Hiring in the healthcare industry is competitive and GoodHire makes it easy to verify your applicants’ qualifications and licenses. Our streamlined, mobile-optimized platform results in a faster background check process for more efficient hiring and a great candidate experience, while giving you peace of mind with built-in compliance features. To learn more about GoodHire’s comprehensive healthcare screening services, reach out to our sales team.
The resources provided here are for educational purposes only and do not constitute legal advice. We advise you to consult your own counsel if you have legal questions related to your specific practices and compliance with applicable laws.