Feds say beware of the scorned, banished provider
Federal regulators are on the lookout for health care institutions that continue to employ or otherwise work with individuals given the Medicare kiss of death, says a prominent attorney. He cautions that health care organizations risk a great deal by continuing to work with such people.
The Office of the Inspector General has made it clear that it is looking for such allegiances and will punish them severely, says Mark Kadzielski, JD, head of the West Coast health practice for the law firm of Akin Gump in Chicago. When the federal government "debars" or "excludes" individuals from participation in federal programs such as Medicare because of fraud or other misdeeds, no organization participating in Medicare or other programs may employ that person in any position with direct responsibility for or involvement with business operations related to the federal program. Furthermore, the person may not be employed in such a way that his or her salary or other compensation are derived, even indirectly, from any federal funds.
As a practical matter for most facilities, that means the person cannot be employed or a physician may not have privileges at a facility receiving federal funds. But Kadzielski says many such people still are affiliated with hospitals and other facilities. To determine whether a person is debarred or excluded, providers can check the OIG’s database on the Internet at www.hhs.gov/oig/cumsan/index.htm.
"You should consider automatic termination after you go on that Web site and find them there," he says. "The argument is always that the doctor is a wonderful clinician, and you don’t want to fire him for missing a student loan payment or checking the wrong box on a Medicare form. Wrong answer! Debarred or excluded providers are a major danger, and you must sever ties with them immediately."
Kadzielski says federal inspectors will be looking for any such people when they visit a facility, and it is easy for them to make the connection since they only have to check their database against the facility’s records. "They will be looking for them at every opportunity, and it’s an easy way for them to slap you with a penalty," he says.
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