In the continually evolving environment of healthcare, there is a critical aspect rarely understood by even seasoned legal professionals – exclusion screening. Routine screening checks are compulsory in the healthcare sector. Still, the importance of exclusion screening trumps most compliance audits, especially concerning federally funded health care programs.
The Office of the Inspector General (OIG) under the Department of Health and Human Services has the authority to exclude certain individuals and entities from receiving compensation. This power extends to organizations, such as Medicare Advantage Organizations (MAOs) and Medicare Prescription Drug Plans (PDPs). This regulatory reach is implemented through the List of Excluded Individuals/Entities (LEIE).
Employers should be aware of the potential penalties they can face if they hire an individual on the LEIE. The penalties are not merely financial – the reputational damage to the employer (be it a corporation or a law firm) can also be severe. Plus, the legal complications arising from such an employment decision can be extensive.
The Office of the Inspector General has been actively reporting a series of recent settlements with entities who violated these guidelines. Keeping an eye on such leads is a good practice for employers to understand the potential repercussions of hiring excluded individuals.
For corporations or law firms with a significant interest in healthcare representation, a clear understanding of this regulatory landscape is a must. It is an investment that ensures effective risk management, vital for the sustainability of the organizations in the long run.
Given the vast number of legal professionals and the increasing complexity of regulatory compliance, exclusion screening is a necessity, not a choice. By integrating such measures into their recruitment and retention practices, organizations can help secure their legal, financial, and reputational standing in the competitive healthcare industry.