OIG Issues Updated Special Advisory Bulletin on Excluded Individuals

On May 8, 2013, the Office of the Inspector (OIG) issued an updated “Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs.”  Ambulance providers enrolled in Federal healthcare programs may not employ or contract with any party who is excluded from participating in such programs.  Doing so could subject your service to penalties and disqualify your agency from receiving reimbursement for services rendered by (or ordered by) an excluded party.  Since 1999, the OIG has recommended that providers “periodically” screen their prospective and current employees and contractors for exclusions.  The OIG is now updating its screening guidance. 
What Your Agency Needs to Know
·         Monthly Screening.  The OIG is recommending that providers check the OIG’s “List of Excluded Individuals and Entities” (LEIE) on a monthly basis to screen their current staff and any parties they do business with. 
·         Screen Anyone Who Provides Services for Your Agency.  The Bulletin makes it clear that any excluded party that performs services on your behalf can disqualify you from Federal healthcare program reimbursement and subject you to penalties (including potential overpayment obligations).   In fact, the Bulletin says this includes anyone involved in “transportation services,” including “ambulance drivers or ambulance company dispatchers.”  This means that your service should screen everyone - from the owner, chief or director to your EMTs and paramedics, billers, managers and other staff, paid or volunteer.  Any individual (volunteer or employee) involved in providingbilling, or overseeing ambulance services at your organization should be screened on a monthly basis though the LEIE
·         Screen Healthcare Providers who Sign PCS Forms.  In addition, Medicare will not pay for services that are orderedby excluded persons, and the OIG recommends that providers ensure that the ordering physicians or other providers are not excluded.  Healthcare providers who are authorized to sign physician certification statements (PCS) may be considered to be providers that order non-emergency transportation services.  As such, we recommend that your ambulance service screen physicians and other health care professionals who sign PCS forms though the LEIEbefore submitting claims ordered by these parties.
·         Screen Contractors and Subcontractors.  Any individual that your agency contracts with for services - from your medical director to your billing agency - should be screened using the LEIE.  You should also require your contractors to screen their employees and subcontractors and make sure that the contractor is conducting such screening (by requesting screening documentation from the contractor, or written assurances that they have done so). 
Learn more about these new screening requirements at abc3 this spring.