decisionhealth Newsletters, Part B News - 2013 Issue 6 (June)
OIG: Hire excluded workers -- even through third parties -- and risk fines
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Article Overview
This article summarizes an HHS Office of Inspector General advisory on exclusion-related compliance risk for healthcare providers. It focuses on the responsibilities of billing entities, the potential exposure created by employees, contractors, subcontractors, volunteers, and staffing vendors, and the kinds of exceptions and verification practices discussed in the guidance. The piece is relevant to compliance officers, administrators, billing teams, and healthcare leaders who oversee vendor relationships and exclusion screening.
Why This Topic Matters
Providers can face overpayment liability and civil monetary penalties if excluded individuals perform work tied to federal claims, including through third parties. The article helps readers understand the scope of the compliance risk and the importance of vendor oversight and exclusion screening.
Article Sections
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Compliance
Introduces the OIG advisory and the general compliance concern involving excluded workers and federal claims.
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The buck stops with you
Discusses provider responsibility for excluded individuals associated with billing entities and third-party arrangements, along with broad compliance implications.
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Exceptions rare, difficult
Reviews the narrow exception concepts mentioned in the advisory and the challenges of separating excluded personnel from federal program-related work.
What You Will Learn
- The compliance risks associated with excluded individuals in healthcare organizations
- How third-party staffing and subcontracting can create exclusion-related exposure
- The role of exclusion screening and vendor oversight in managing risk
- The general scope of the OIG advisory and its compliance implications
Who Should Read This
- Healthcare compliance professionals
- Billing and reimbursement staff
- Practice managers
- Facility administrators
- Healthcare attorneys
- Vendor management teams
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