First Quarter 2015 – OIG’s Enforcement Actions Against Organizations That Hire Excluded Individuals

During the first quarter of 2015, the Department of Health and Human Services Office of Inspector General (OIG) reported on 10 cases where healthcare organizations employed excluded individuals. In all cases, the healthcare organizations knew or should have known that the individuals were excluded, and in all cases the healthcare organization self-disclosed the conduct to the OIG.

• Reported on January 7, Healthcare Authority for Medical West in Alabama agreed to pay $431,041.28 for allegedly violating the Civil Monetary Penalties Law for employing an excluded individual.
• Reported on January 23, pharmacist Joseph C. Moon of Minnesota agreed to pay $96,259.57 to settle allegations that while he was excluded from participation in federal healthcare programs he owned and managed a pharmacy that participated in federal healthcare programs between March 10, 2006 and July 17, 2013.
• Reported on January 30, Affinity Medical Center, LLC operating as Trinity Medical Center in Alabama agreed to pay $111,969.11 for allegedly violating the Civil Monetary Penalties Law for employing an excluded individual.
• Reported on February 4, Agape Homes, LLC in Arizona agreed to pay $41,995.30 for allegedly violating the Civil Monetary Penalties Law for employing an excluded nurse.
• Also reported on February 4, Valley Presbyterian Hospital in California agreed to pay $121,316.55 for allegedly violating the Civil Monetary Penalties Law for employing an excluded individual that they knew or should have known was excluded.
• Reported on February 6, Bourne Management Systems, Inc. and Bourne Manor Nursing, LLC operating in Massachusetts agreed to pay $123,893 for allegedly violating the Civil Monetary Penalties Law for employing an excluded individual that they knew or should have known was excluded.
• Reported on February 25, Denver North Care Center operating in Colorado agreed to pay $242,434.92 for allegedly violating the Civil Monetary Penalties Law for employing an excluded individual that they knew or should have known was excluded.
• Reported on March 16, Advance Home Health Care Services, Inc. in Texas agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law for employing an excluded individual.
• Reported on March 19, Ambulatory Health Care Services, LTD., operating in Illinois, was excluded for three years for hiring a nurse it knew or should have known was excluded. Subsequently, Ambulatory Health Care Services, LTD. is no longer in business.
• Reported on March 31, Trinity Mission & Rehab, operating in Virginia, agreed to pay $399,573.85 for allegedly violating the Civil Monetary Penalties Law after it self-disclosed it hired an excluded individual.

These enforcement cases highlight the very need to ensure all individuals and vendors are screened for exclusions prior to hire or prior to contracting with them for services or products. Month after month the OIG continues to crack down on providers who are improperly hiring individuals and engaging with vendors and contractors without conducting screenings against the List of Excluded Individuals and Entities.

Screening for program exclusions should be viewed by your organization, and especially by executive management, the compliance officer and the Board of Directors, as a necessary part of doing business in the healthcare industry. Individuals and businesses can be excluded for a number of reasons, i.e., offenses related to the delivery of care; patient abuse or neglect; fraud, theft and other financial misconduct; and felony convictions related to controlled substances. Therefore, to protect your business, and especially the welfare of your patients and employees, sanction screening is a necessary part of the business.