SureCheckUSA OIG Exclusion Checks. The Health and Human Services Office of Inspector General’s (OIG) mission is to detect and root out fraud in Federal health care programs, including Medicare and Medicaid. Fraud diverts scarce resources meant to pay for the care of patients and other beneficiaries.
OIG’s efforts to curb fraud include:
- Conducting criminal, civil, and administrative investigations of fraud and misconduct related to HHS programs, operations, and beneficiaries.
- Using state-of-the-art tools and technology in investigations and audits around the country.
- Imposing program exclusions and civil monetary penalties on health care providers because of criminal conduct such as fraud or other wrong doing;
- Negotiating global settlements in cases arising under the civil False Claims Act, developing and monitoring corporate integrity agreements, and developing compliance program guidance.
The number of investigations, convictions and fines collected by OIG along with state and federal law enforcement has steadily continued to rise each year. Healthcare compliance departments can be overwhelmed with performing monthly searches of all federal and state exclusion and sanction lists for employees, contract workers and vendors. Improperly billing Medicare or Medicaid for services provided in part or whole by individuals or vendors currently excluded may result in significant fines.
The Department of Justice obtained more than $3 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending Sept. 30, 2019. Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $62 billion.
Below are just a few of the recent fines imposed on healthcare providers for filing such claims:
- July 2020 – Texas nursing facility $143,000
- June 2020 – Florida practice $94,000
- May 2020 – South Carolina ambulance service $2.2M
- April 2020 – New Mexico physician and practice $199,000
- March 2020 – North Carolina ambulance service $342,000
- February 2020 – Maryland hospital $106,000
- January 2020 – Illinois physician $130,000
- December 2019 – Maryland dentist $94,000.
- November 2019 – Texas endoscopy center $121,000.
- October 2019 – Indiana nursing facility $51,000.
- September 2019 – Texas physician is fined $53,000.
- June 2019 – Illinois hospital $125,000.
- May 2019 – Tennessee hospital $102,000.
**source US Dept Health and Human Services OIG
SureCheckUSA’s service provides secure automated monthly checks of federal and state exclusion and sanction data sources. These include LEIE, SAM, OFAC, FDA, Medicare Opt Out, SSA Death Master File and available state exclusion lists. The SureCheckUSA service is an inexpensive way for healthcare facilities to exercise due diligence in searching exclusion and sanction lists on a monthly basis. Improper billing for services related to an excluded individual or entity is easily avoided with SureCheckUSA’s monthly OIG sanction exclusion check service. Additionally, our experienced staff perform all necessary resolutions of search results freeing up your staff’s valuable time.
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