Heavy Fines for Health Providers Hiring Excluded Persons

Forty-one of fifty states and the District of Columbia require a criminal background search on home health agency employees. The number is expected to grow by at least four more states soon. These healthcare background checks are typical of the kind run by all health care providers from hospitals to private practices. In most cases, an applicant’s fingerprints are scanned through a state database and a national database and county criminal search is also performed. Hiring excluded persons is prohibited when a provider accepts Medicare or Medicaid.

Patient and Employee Safety

One reason that background checks for all healthcare employees is popular, is the responsibility employers have in making sure that patients and employees are in a safe environment. Criminals, especially violent ones, can, in a single incident, bring so much bad publicity to a facility or practice that it takes years to recover.

Hiring Excluded Persons

When providers accept Medicare or Medicaid, the need for a more extensive background check for all employees is not a luxury but is an absolute necessity. On October 24th, 2014, the Office of Inspector General (OIG) for the United States Department of Health and Human Services (HSS) reached a settlement in the amount of $357,341.96 with Daybreak Venture LLC. Daybreak is the general partner of 74 skilled nursing and long-term care centers scattered all over Texas. According to HHS, seven Daybreak owned facilities hired employees who are excluded from employment with federal health programs or providers who accept Medicare and/or Medicaid. Billing for services provided by these people and subsequently discovered by the OIG has severe penalties.

How Severe are the Penalties when Hiring Excluded Persons?

First, 100 percent of the money collected for services provided by excluded personnel are refunded to the Federal Government.

Then there are the civil money penalties (CMP) as well. Employers who hired an excluded person and then billed for any services, that they provided to any federal health program for services, is subject to a fine of $10,000 per occurrence. So, a physician or hospital who hires a Physicians Assistant who is an excluded person can be fined $10,000 for each and every charge made for work done by that person. CMP fines add up quickly and can easily surpass the amount of the restitution. According to a Special Bulletin published by the OIG, the effect of an exclusion is to

“…preclude employment of an excluded individual in any capacity by a health care provider that receives reimbursement, indirectly or directly, from any Federal health care program.”

Incidentally, the OIG suggests in the same bulletin that rechecks be done periodically for all staff.

Protect Yourself and Your Company

Using an experienced employment screening service can help with the tedious tasks of checking databases for normal criminal activities and for individuals who may not have been convicted of a crime, but are on the OIG List of Excluded Persons. Quality employment screening services have access to databases that are not on a normal business’s radar.

Disclaimer Statement: All information presented is for information purposes only and is not intended to provide professional or legal advice regarding actions to take in any situation.

Sources: www.burr.com