How Mandatory Exclusions Differ from Permissive Exclusions

Posted by Frank Strafford on January 28, 2015 in Exclusion Screening, Exclusions, Mandatory Exclusions and Permissive Exclusions,

Do you know the differences between Mandatory and Permissive Exclusions?

Mandatory Exclusions, as the name presumes, are compulsory for a five year minimum term, when an individual has committed any of the applicable criminal offenses (listed below). The OIG is required by law to adhere to this standard.

On the other hand, Permissive Exclusions are foisted on an individual at the OIG’s own discretion and the offenses do not even have to be healthcare related. Although there isn’t a 5 year minimum, there are minimum terms for some permissive authorities.

It’s also important to mention that based on new provisions in the Affordable Care Act, the OIG proposed new rules that would significantly expand the OIG’s exclusion power for permissive exclusions.

What Constitutes a Mandatory Exclusion?

  • Offenses or fraud concerning Medicare, Medicaid, SCHIP, or any state’s healthcare program.
  • The act of abuse or neglect on a patient.
  • Receiving a felony conviction for any financial crime, theft, or fraud committed in a medical capacity.
  • Receiving a felony conviction for illegally distributing, manufacturing, dealing, or prescribing a controlled substance.

Permissive Exclusions can be initiated by the OIG for a number of reasons, including:

  • Defaulting on a student loan.
  • Taking an illegal kickback (negotiated bribery).
  • Deceiving a federal healthcare program with false or dishonest claims/information.
  • Receiving a misdemeanor conviction for any fraud committed in a medical capacity.
  • Receiving a misdemeanor conviction for illegally distributing, manufacturing, dealing, or prescribing a controlled substance.

Exclusion can ruin a doctor or healthcare provider’s career as it would likely prevent them from getting any form of employment in a healthcare capacity, so be sure to always stick to the letter of the law. Exclusions can also severely set-back a healthcare facility that is caught employing an excluded individual, so it’s imperative to vigorously monitor the OIG exclusion list to ensure that new hires and current employees are not excluded.

How does your healthcare facility screen employees? Contact Streamline Verify today to see how we can help you improve your screening process!

About Frank Strafford

About Frank Strafford

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