Although criminal background screening, occupational health screening, and drug tests are an indispensable part of the screening process for candidates and existing employees in the healthcare industry, there’s another key step that employers sometimes miss, or conduct without qualified professional support.
Organizations in the healthcare industry concerned with long-term legal compliance and maintaining patient safety should consider the benefits of conducting Office of Inspector General (OIG) background checks when hiring or rescreening nurses, physicians, and other healthcare personnel. An OIG background check identifies excluded individuals and entities with past misdemeanors or felonies related to a variety of work-related offenses. An OIG background check ensures compliance with federal regulations, ongoing access to federal healthcare program funding (Medicare, Medicaid), patient safety, and protection from legal, financial, and reputational harm.
What is the OIG Exclusion List?
The Office of Inspector General’s (OIG) Exclusion List refers to the List of Excluded Individuals/Entities (LEIE), which identifies all individuals and organizations excluded from federal healthcare programs, including Medicaid and Medicare. When accessed, the list specifies why an individual or entity is excluded: whether for Medicare/Medicaid fraud, Licensing Board Action, Default on Health Education Assistance Loans, Patient Abuse/Neglect, or manufacturing or dispensing controlled substances.
To ensure thoughtful risk management and avoid sizable monetary penalties (up to $10,000 per day when employing an excluded individual), healthcare employers should work with a background screening provider that incorporates and expedites OIG exclusion list searches as part of their screening process for candidates and existing employees.
Failure to conduct proper healthcare compliance checks or federal exclusion checks on potential new hires or employees can also lead to disqualification from federally-funded programs like Medicaid and Medicare while exposing vulnerable patients and even current personnel to acts of fraud, harm, negligence or malpractice.
How an OIG Background Check Works
Conducting an OIG background check includes accessing the LEIE/OIG exclusion list database to identify whether a candidate or existing employee is currently excluded from participation in a state or federal healthcare program. This Inspector General background investigation is one significant part of a wider compliance background screening process, which can sometimes include the added utilization of the federal System for Award Management (SAM) database to identify contractors excluded from government work, or the use of state Medicaid exclusion lists (currently available in 42 states, including New York).
The Orsus Group conducts comprehensive background screenings for employers in the healthcare industry, using OIG, state Medicaid, and SAM databases to quickly identify individuals or entities that could be a risk to your organization, patients, and workforce.
When reviewing OIG/LEIE exclusions, they are classified as either permissive or mandatory.
Permissive exclusions usually involve misdemeanors ranging from license suspension to convictions for healthcare fraud, controlled substance distribution, or failure to provide services that meet professional standards of care. These exclusions typically remain in the database for up to three years.
In contrast, mandatory exclusions involve felony-level convictions ranging from federal fraud (Medicare or Medicaid), large-scale distribution of controlled substances, financial misconduct/theft, and patient abuse or neglect. Mandatory exclusions remain in the database for specific periods of time depending on the number of offenses:
- 1 exclusion – the individual remains on the exclusion list for five years
- 2 exclusions – the individual remains on the exclusion list for 10 years
- 3 or more exclusions – the individual remains on the exclusion list indefinitely
Who Should Get an OIG Background Check?
Since organizations in the healthcare industry work with a number of vulnerable individuals and must staff qualified personnel in a wide number of roles and professions, it’s important for employers to screen all new hires and existing employees to ensure responsible patient care, the safety of other employees, and protection from legal penalties or lawsuits resulting from negligent hiring.
The most common examples of healthcare workers and contractors who undergo OIG background checks include the following:
- Physicians
- Nurses and certified nursing aides
- Technicians
- Pharmacists and pharmacy employees who enter prescriptions
- Hospital employees and nursing home employees
- Paramedics, ambulance drivers, emergency medical technicians (EMTs), ambulance dispatchers
- Social workers
- Home health agency employees
- Administrative services employees
- Accountants, claims processors, utilization reviewers, billing agents
- Those who deliver or sell medical devices and equipment
- Volunteers
Employers should be aware that the OIG sends a Notice of Intent to Exclude (NOI) when an individual is under review for exclusion. Since an individual who receives an NOI can send materials in their defense and even appeal an exclusion decision, employers can sometimes unknowingly hire an employee with a NOI and fail to re-screen them soon after (when the employee is then officially on the exclusion list). For this reason, we recommend not only conducting pre-employment OIG background checks, but screenings at regular intervals to avoid potential legal and financial issues.
OIG Compliance
The Office of Inspector General exclusion list is part of the Social Security Act, and though it does not strictly require employers to complete OIG background checks on employees, employers can be severely penalized for hiring or retaining employees or contractors who are actively on the OIG exclusion list.
Pre-employment OIG background checks for potential new hires, as well as regular OIG checks for existing employees, can help prevent all of the following penalties:
- Civil monetary penalties of up to $10,000 per claim, meaning $10,000 for each day an excluded individual operated/provided service within an organization, or retained control interest/prohibited ownership of the organization.
- Organizational exclusion from federal funding, including Medicaid, Medicare, and other federal healthcare programs
- Potential OIG denial of reinstatement to federal healthcare programs in the future due to past violations
- Required return/repayment of any federal funds received by the organization, beginning with the date an excluded individual was hired
Ensure Workplace Safety and Legal Compliance with The Orsus Group
Employers in the healthcare industry must hire a wide range of employees and contractors to provide responsible patient care. Due to a high volume of recruitment, hiring, and onboarding processes, sometimes OIG-excluded individuals are hired unknowingly and risk exposing your organization to severe federal or state penalties and/or negligent hiring claims resulting from workplace incidents.
Ensure your organization remains compliant and safeguarded against federal sanctions with The Orsus Group's thorough OIG background check services. Contact us today to seamlessly integrate compliance into your hiring process and enjoy peace of mind about your background screening strategy.