Compared to other healthcare sectors, the number of excluded individuals working in nursing homes is on the rise. As a result, long term care facilities, nursing homes and skilled nursing facilities are all seeing an impact from the Special Advisory on the Effect of Exclusions.

“We see a lot of employment of excluded individuals in nursing homes,” says Susan Gillin, deputy chief in the Administrative and Civil Remedies Branch of the DHHS of Inspector General (in an interview with McKnights.com). 

Specifically, the new Special Advisory prohibits excluded individuals from providing goods or services at a healthcare facility, including non-direct patient care such as administrative, food service, health information technology and human resource roles. Even excluded temporary workers and volunteers cannot provide services if the long term care facility submits items for reimbursement from federal or state healthcare programs. With that said, individuals who show up on the exclusion list still somehow manage to find lower-paying, entry level jobs in the long term care industry. Sadly, it’s a growing problem that won’t slow down anytime soon.

A prime example of this showed up recently with American Senior Communities, who faced liability for employing excluded Nurses, CNA’s and even kitchen workers. They settled with the OIG for a whopping $376,000 for employing seven excluded providers. Ouch.

In addition, we have seen two trends affecting the long term care industry in this area:

1. The use of false Social Security Numbers by Certified Nurse Assistants (CNA) in the workplace. The facts are generally the same – a CNA is given a Social Security Card by his/her parents and the card is actually purchased from a fradulent card maker or re-issued by the fraudulent card maker utilizing a Social Security Number of a deceased individual. The CNA is either unware of the card’s history or, in some cases, a part of the scheme. The issue is that the employer that does not verify the SSN at hire and search against the available Death Master Index (DMF) will be reporting income tax to the wrong person or drawn into an identity theft investigation by DOL and the Secret Service.

2. A situation whereby an employee has been excluded at both the federal List of Excluded Individuals and Entites (LEIE) and a separate state Medicaid exclusionay authority. If the exclusion time frame has expired (typically at least 5 years) AND the individual affirmatively goes through the process of a successful reinstatement (these are not automatic at the natural conclusion of the exlcusionary period), he/she MUST go to both the federal and the state Medicaid authority in order to get reinstated at both. Going just to the federal OIG to get reinstated will not affect the separate state exclusion.

Lessons learned:

  • Check the OIG exclusion list and SAM database on an on-going basis.
  • Don’t forget to also take note of the 27 state Medicaid exclusion lists.
  • Be sure to check all employees – regardless of whether they are licensed or non-licensed.
  • Make sure the individual has sought reinstatement from both the federal list or SAM as well as the state Medicaid authority.
There may be several reasons why these excluded individuals are finding their way into nursing homes and long term care facilities, but whatever the reason, actively searching for excluded individuals will help reduce your chances of large amounts of fines.

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How to Get off the OIG Exclusion List
Long Term Care: Watch out for the OIG exclusion list
History of the OIG Exclusion List: What if it didn’t exist?