In the first blog in this series, we laid out the most salient risks that home health and hospice agencies face today, as identified by Liles Parker PLLC.

This entry will focus on the second risk area, exclusion screening. Long gone are the days when an agency can prevent fraud and abuse just by doing criminal background checks on new hires.  It should also screen agents, contractors and volunteers. “Pursuant to the compliance program, home health agency policies should prohibit the employment of individuals who have been recently convicted of a criminal offense related to healthcare or who are listed as debarred, excluded, or otherwise ineligible for participation in Federal health care programs.” (HHS-OIG Compliance Program for Home Health Agencies, August 1998, Fed. Reg. 42410).

In Texas, HHSC-OIG is very aggressive in its approach towards compliance.  It expects all Medicaid service providers to check the OIG’s State Medicaid Exclusion List https://oig.hhsc.state.tx.us monthly.  The trend of requiring monthly screening checks is expanding due to regulations now prohibiting any person excluded from Medicaid in one state from working in any state Medicaid program.

There are two other databases agencies can use to perform nationwide “Due Diligence” Searches:

1. SAM-System for Award Management

2. LEIE-Federal List of Excluded Individuals & Entities

A couple of examples of why all agencies must perform exclusion screenings is to prevent incidents like the one that occurred on 03/19/2015 when a Skokie, IL home health agency employed an excluded nurse.  As a result the HHA was excluded for three (3) years from participation in all federal health care programs; or on 04/26/15 when A Drexel, PA personal in-home care provider paid $69,130 in CMPs for employing an excluded individual for 18 months between July 2010 and December 2011.  Per www.exclusioinscreening.com the average penalty assessed in 2015 was $114,436.52

In conclusion, “exclusion screening” is prominently covered in HHS-OIG’s 2016 Work Plan.  It is your responsibility to screen all staff, agents and contractors employed by you.  Should you fail to screen and hire an excluded individual, strict liability will be applied by the government.

In the next blog posting we will continue to review a number of the specific concerns identified by the OIG which an agency’s compliance plan should ensure are addressed.