Adapted from an article in Virginia Nurses Today by Andrea J. Sloan
Summarized for this publication by Barbara Grove, RN

The Office of the Inspector General (OIG) List of Excluded Individuals/Entities is one exclusive club that no health care professional wants to join. This “club” resulted from national efforts to protect the health and welfare of the nation’s elderly and poor. Congress implemented legislation to prevent certain individuals and business from participating in federally funded health care programs. The List of Excluded Individuals/Entities, which is a list of all currently excluded parties, is maintained by the OIG and is available online.

Mandatory exclusions will be imposed upon individuals convicted of:

• Medicare or Medicaid related crimes, including both felonies and misdemeanors
• Patient abuse or neglect, including felonies and misdemeanors
• Felony health care fraud not related to Medicare or Medicaid
• Felony controlled substance violations

Permissive exclusions may be imposed upon individuals or entities convicted of:

• Misdemeanor health care fraud not related to Medicare or Medicaid
• Misdemeanor controlled substance violations

Permissive exclusions may also occur for:

• Disciplinary actions taken by licensing boards, such as the Board of Nursing
• Disciplinary actions taken by other federal and state health care programs
• Quality of care issues related to the denial of services, substandard care, or the provision of unnecessary or excessive services
• Prohibited activities such as false claims, kickbacks, or fraud (even where there has been no conviction)
• Defaults on health education assistance loans

The length of exclusion varies according to the violation. Felony convictions carry a mandatory five-year exclusion period. Even if the felony conviction is pardoned, the individual must wait the five years before petitioning to be removed from the list.

Exclusion means that an excluded individual may not, either by direct employment or subcontract, furnish, order, prescribe, or in any way supply health care services that would be paid for by federal funds. Providers and contracting entities have an affirmative duty to check the program exclusion status of individuals and entities prior to entering into employment or contractual relationships or they run the risk of civil monetary penalties (CMP) liabilities if they fail to do so. The Exclusion List is readily available on line at www.oig.hhs.gov, then click on Exclusion Database.

The complete article can be found at: http://nursingald.com/uploads/newsletters/VA072006.pdf.