Search the internet on OIG enforcement and you will eventually find articles about nurses, physicians, pharmacists and other licensed medical personnel and their travails related to OIG exclusion. A common theme running through the articles is how unaware most were about the power of the OIG to seriously impact their lives and careers through the power of exclusion.
The Reach of the OIG
The Department of Health and Human Services Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded healthcare programs such as Medicare, Medicaid, Veteran’s Administration, Indian Health Services and others.
The practical effect of such exclusion is that excluded individuals or entities cannot be paid for their services or items provided, directly or indirectly, under a federal healthcare contract. This payment prohibition applies to all methods of federal healthcare program payment and applies even if the payment is made to a person that is not excluded. This prohibition on payment also extends to any individual or business who employs or contracts with an excluded individual or entity. In fact, employing or contracting with an excluded individual or entity can expose an employer to civil monetary penalties.
How Does this Happen
Exclusions by the OIG fall into two categories – mandatory and permissive OIG exclusions. The OIG has very little discretion when it comes to mandatory exclusions but has greater latitude in deciding how to manage lesser offenses with permissive exclusions.
Once a provider or entity is excluded by the OIG under either category, the result is the same: an individual or entity cannot receive payment for services under a federal healthcare program, either directly or indirectly, while excluded and on the LEIE. This effectively eliminates their ability to work in virtually all health care organizations.
What You Don’t Know….
Several common themes run through comments posted by individuals who discovered that they were on the OIG’s exclusion list:
First, many were entirely unaware of the OIG and its power to impact their ability to work in the healthcare field once excluded. While they may acknowledge their personal duty to educate themselves about legal requirements related to their fields, they expressed disappointment that their clinical training did not include courses that addressed the regulatory dangers which can trigger a reaction by the OIG. As one nursing professional related in a recent post: “I am currently on the exclusion list. My case was a tough pill to swallow, blindsided by not knowing what I was doing was against the law. Scolded for not knowing nursing law and rule which I understand now. Confused on why this type of information is not in any nursing curriculum.”
Second, the discretion of the OIG to impose permissive exclusions creates ambiguity regarding why some people are excluded and others are not. The OIG’s discretion to apply permissive exclusions and the timing of such exclusions can result in significant anxiety and frustration. Multiple nursing professionals reported their experiences with the OIG on allnurses.com. As one nurse reported: “The occurrence that I was involved with happened in another state and in 2001. I did not find out about the OIG list until May of 2009. I had worked in several areas and it did not come out. I had no idea what it was when I was informed. I don’t know when my actual name was placed on the list. I was NOT informed of the OIG’s list or their intent before my name was placed on it. It took years before I knew. I was able to remove myself and the AG’s office was helpful.” Another nurse expressed confusion about the process and why a voluntary license surrender was reported to the OIG: “I voluntarily surrendered my license for no other reason than I left the state and was not planning on returning and I was reported to OIG.”
Third, healthcare professionals reported that they were unprepared for the ripple effect of exclusion on their careers. Unbeknownst to many, an OIG exclusion follows you from state to state, in whichever role you may take in the healthcare field. For example, if you are excluded as a nurse, you are also prohibited from serving in any other capacity such as managerial, administrative or clerical. You cannot be employed by any organization that is even remotely connected to health care if it accepts federal funds including hospitals, clinics, social service agencies, long term care facilities, custodial service companies, billing services, healthcare insurers, managed care facilities, and research groups, not even as an unpaid volunteer.
Excluded status permeates the entire healthcare field until it expires. In some instances, even a healthcare employer not participating in a federal program may check the LEIE to assure that a job applicant has not engaged in past criminal behavior related to healthcare.
The impact of an OIG exclusion is not necessarily the death knell for a career in healthcare. There are steps that you can take to remove your exclusion status, including hiring legal counsel who specializes in addressing OIG exclusions before the OIG places you on the list and applying for reinstatement after expiration. Also, educating yourself about the reach of the OIG and the legal requirements of your profession is critical to avoid the pitfalls reported by those who failed to do so and experienced the full force of the OIG on their lives and livelihood. As one physician who was excluded but was later reinstated shared in a recent article, “I wish I had known about the LEIE and how the whole thing worked when all this began. Nobody does. When I tell other physicians about all this, they’re amazed. They have no idea what the exclusion list is.”