Don’t Forget to Check Excluded Status

Background checks aren’t just for spotting criminal records. Are you checking the Office of Inspector General’s List of Excluded Individuals and Entities (LEIE)? In 2013, the Office of Inspector General issued a Special Advisory Bulletin highlighting the issue. No federal health care program payment can be made for any item or service that is furnished by an excluded person or at the medical direction or prescription of an excluded person. Excluded individuals also can’t serve in an executive or leadership role or provide management services such as HIT, billing and accounting, or staff training for a provider that bills federal health care programs. Most relevant for laboratories is the prohibition on payment for items or services “furnished at the medical direction or on the prescription of an excluded person.”

The OIG’s Bulletin advised: “Many providers that furnish items and services on the basis of orders or prescriptions, such as laboratories, imaging centers, durable medical equipment suppliers, and pharmacies, have asked whether they could be subject to liability if they furnish items or services to a Federal program beneficiary on the basis of an order or a prescription that was written by an excluded physician. Payment for such items or services is prohibited. To avoid liability, providers should ensure, at the point of service, that the ordering or prescribing physician is not excluded.”

Providers can face civil monetary penalties for billing for services linked to an excluded person—up to $10,000 for each item or service furnished by the excluded person and billed to a federal program. In March 2015, a health care system serving parts of Indiana and Ohio agreed to pay more than $120,000 to settle allegations it employed a laboratory technician who was an excluded individual and provided items and services to patients that were billed to federal health care programs.

To check excluded status of individuals, laboratories can use the OIG’s LEIE online searchable database available on its website, oig.hhs.gov, under the tab Exclusions.