Does Employer need Employee Permission to Monitor for OIG Exclusions?

Employers have an initial Release and Authorization to conduct a pre-employment background check upon hire. A proper release will contain additional language that allows the employer to conduct additional searches “during the scope of the employee’s tenure” with the company. The employer is allowed to conduct additional searches without obtaining a new release in the event of a substantiated inquiry into fraud or other illegal activity.

Further, an employer is required by the OIG to conduct monthly monitoring of its employees and vendors (PPACA 6501).  It is incumbent on the employer to monitor its staff and vendors to ensure that it is not billing CMS for individuals or entities that are “excluded” by the OIG, GSA/SAM or any state Medicaid exclusion list. There are 25 state Medicaid OIG exclusions list that should be added to the OIG List of Excluded Individuals and Entities.

The healthcare company and its owners can be excluded. A fine for billing and receiving CMS reimbursement for an excluded individual or entity is typically $10,000 per item billed, plus up to three times the total reimbursed amount by CMS. This can add up quickly and multiply for each provider or entity on the exclusion lists.

Therefore, the law compels healthcare organizations that are billing and receiving reimbursement from CMS to monitor its employees and vendors.  No additional Release or permission is required.

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