Just over a month into 2015, the Office of the Inspector General of the U.S. Department of Health and Human Services has already imposed fines totaling more than $555,000 on four healthcare providers. All four entities settled in order to avoid further penalties.
“The Office of Inspector General’s heightened attention on exclusions and increased fines underscores how vitally critical it is for healthcare facilities to take the necessary steps in establishing a comprehensive and full-proof method of screening their employees to assure they remain compliant,” says Jeff Josefovic, Director of Operations, Streamline Verify.
One case, that of a Georgia physician, had to do with submission of fraudulent Medicare claims. Dr. Dennis Conrad Harper agreed to pay over $305,000 to settle allegations that he overbilled for urine testing in his office.
The three other cases are all related to a list kept by the OIG, prohibiting certain individuals from being employed by or contracting with healthcare providers who receive funds from federal health programs. Employers are required to screen employees against this List of Excluded Individuals and Entities in order to ensure compliance.
Most recently, a group home in Arizona allegedly hired a nurse on the exclusion list and allowed that nurse to care for patients. Agape Homes settled the case on Feb. 4 for nearly $42,000.
On Jan. 30, Trinity Medical Center in Alabama agreed to pay nearly $112,000 in connection with the alleged hiring of an excluded individual, and on Jan. 23, Minnesota pharmacist Joseph C. Moon entered into a $96,000 settlement over claims that he operated a pharmacy while on the exclusion list.
All four settlements were reported on the OIG’s public website, oig.hhs.gov.
OIG Cracking Down
The settlements are a clear manifestation of the OIG’s promises to be tougher on violations.
Healthcare providers are now required to have compliance programs under the Affordable Care Act, and are encouraged by the OIG to run monthly exclusion checks on employees to avoid ending up on the wrong side of an investigation.
Some healthcare organizations choose to keep this screening in-house, while others outsource it to software companies and investigation firms. But regardless, employers are held responsible should they hire or contract with excluded individuals.
The OIG has a financial incentive to be vigilant, as well, since these violations can produce quite a bit of revenue with minimal investigation. With all those factors taken into account, industry experts say, careful screening should be a major part of overall compliance efforts.