October 30, 2009

Fraud Control Considerations for OIG Exclusion List Announced by Medicaid

A Provider Bulletin released by the Indiana Office of Medicaid Policy and Planning ("OMPP") on September 23, 2009, signals a renewed movement towards strictly enforcing the Office of Inspector General's ("OIG") List of Excluded Individuals and Entities ("Exclusion List").  Under federal law, providers are prohibited from hiring an individual or other entity who has been excluded from participation in the Medicare or Medicaid programs ("Federal Programs"), where that individual or entity would be providing any service or item for which payment would be made under such Federal Program.  An employer's failure to ensure an employee or other contracted entity is not on the OIG Exclusion List implicates potential liability to Civil Monetary Penalties and/or exclusion.

Although the general exclusion policy was discussed by the OIG in a September 1999, Special Advisory Bulletin, OMPP's recent issuance of the Provider Bulletin and renewed interest in monitoring reviews of the Exclusion List should serve as notice to Indiana Medicaid providers that policies related to checking the OIG Exclusion List must be reviewed and followed to avoid the possibility of penalties.  In the September 1999, Special Advisory Bulletin, the OIG recommended employers check the Exclusion List prior to hiring or contracting with individuals or entities.  The OIG also recommends periodically checking thereafter as monthly updates are provided to the on-line Exclusion List.  The OMPP Provider Bulletin, however, takes a more strict reading of the requirement and indicates employers should check the OIG Exclusion List on a monthly basis.  

If you have questions or concerns, please feel free to contact Hall Render attorneys:
Todd Selby, tselby@hallredner.com, 317.977.1440,
Brian Jent, bjent@hallrender.com, 317.977.1402, or
Mark Douglas, mdouglas@hallrender.com, 317.977.1485. 

Helpful Links

OIG Website- Exclusions Program:
http://www.oig.hhs.gov/fraud/exclusions.asp

OMPP Provider Bulletin 9/23/2009:
http://www.indianamedicaid.com/ihcp/Bulletins/BT200934.pdf