Health care entities participating in federal funding programs have been undergoing massive re-evaluations of their screening practices over the past year. If your organization has not taken a close look at your screening practices, the start of 2015 is a great time to re-assess and expand the scope of your exclusion screening practices, the frequency of your screening and the individuals you are choosing to subject to exclusionary screening. The low-level consequences of failing to comply can be fatal to even a healthy ongoing health care concern: imposition of civil monetary penalties (CMPs) of up to $10,000 for each item or service furnished by an excluded person as well as an assessment of up to three times the amount claimed. Total exclusion can be the impact in more serious cases.
Why the big push from health care entities to “re-write” their exclusionary screening practices? On May 8, 2013, the Department of Health and Human Services (“HHS”) Office of Inspector General (OIG) released a revised Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs (2013 Bulletin) which can be found at https://oig.hhs.gov/exclusions/effects_of_exclusion.asp. This updated guidance superseded and replaced the OIG’s original 1999 Special Advisory Bulletin (1999 Bulletin) discussing the same topic. The 2013 Bulletin significantly expanded the scope, extent and frequency of exclusionary screening practices for any participating health care entities or providers.
Specifically, the 2013 Bulletin addressed the impact of the Affordable Care Act of 2010 (“ACA”) which directly extended Civil Monetary Penalty liability exposure not only to employees and contractors, but also to other practitioners and individuals who deliver items and services covered by the excluded provider. In addition to physicians and licensed healthcare workers, the 2013 Bulletin makes it clear that pharmacists, transportation service providers, administrative and management service professionals are all examples of individuals who should also be screened for exclusion from participation.