Four Steps that Health Care Providers Must Take When Employing or Contracting With Employees, Physicians, Vendors and Other Affiliated Parties
Health care providers participating in governmental health care programs, including Medicare or Medicaid, must confirm, when employing or contracting with a physician, employee, vendor or other affiliated party, that the individual or entity is not excluded from participation in any governmental health care program.
The U.S. Department of Health and Human Services Office of Inspector General (“OIG”)has the authority to impose civil monetary penalties against any health care provider that employs or contracts with an individual or entity that the provider knows or should know is excluded from participating in any federal health care program, including Medicare. Furthermore, most state governments also impose sanctions against health care providers that employ or contract with individuals or entities that are excluded, on either the federal or state level (or both), from participating in governmental health care programs.
Accordingly, health care providers must, prior to employing or contracting with any individuals or entities and periodically during the term of the employment or contract, confirm whether the individual or entity is excluded, debarred or suspended from participating in any federal or state-specific health care program.
Health care providers can use the following four steps to conduct their participation investigations when employing and/or contracting with individuals or entities:
1. Initial Review. When conducting your initial review, it is critical that the proposed employee or contractor be reviewed on both a federal and state-specific level.
a. Federal Review. The following websites contain information concerning individuals and entities excluded from federal health care programs and are excluded from receiving federal contracts, certain subcontracts, and certain federal financial and nonfinancial assistance and benefits:
· http://oig.hhs.gov/exclusions/exclusions_list.asp
· https://www.epls.gov/epls/search.do
· http://www.treasury.gov/resource-center/sanctions/SDNList/Pages/default.aspx
To obtain the most comprehensive review result, a full criminal background check should be conducted and should incorporate a criminal background review in all fifty states.
b. State-Specific Review. Each state has its own review regulations concerning provider exclusion, debarment, termination and/or suspension. In the State of New York, health care providers are obligated to conduct participation reviews on a monthly basis and, in addition to conducting the federal reviews, New York State based reviews should, at a minimum, focus on the following lists:
· http://www.omig.ny.gov/data/content/view/72/52/
· http://www.op.nysed.gov/opd/rasearch.htm
· http://www.health.ny.gov/professionals/doctors/conduct/
· http://www.op.nysed.gov/opsearches.htm
· http://www.nydoctorprofile.com/welcome.jsp
For a listing of state-specific Medicaid sanction lists, please see: http://www.omig.ny.gov/data/images/stories//state_sanc_url_list.pdf
2. Demand Representations from the Employee or Contractor. Health care providers can ask on employment and/or vendor applications whether the individual or entity is now or has in the past been excluded, debarred or suspended from participating in any federal or state health care program.
3. Document Every Step of the Participation Review Process. Make sure to print the results of each participation review (including the search parameters and results of each individual website that is visited) that you conduct and that you retain in the individual employee/contractor file the results of each exclusion review.
4. Incorporate the Participation Review Plan Into the Organizations Compliance Program. As with any other compliance obligations imposed on a health care provider, it is important to streamline the participation review process by incorporating a set of written guidelines that employees and compliance personnel will follow into the organizations comprehensive compliance program. For more inforamation about comprehensive compliance programs for all health care practices and facilities, please visit the following website.
