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What Detroit Hospice Operators Should Know About the OIG Exclusion List

Under various circumstances, the Office of Inspector General (OIC) has the authority to exclude individuals and entities, including Detroit area hospice operators, from federally funded healthcare programs pursuant to relevant sections of the Social Security Act. The OIG maintains a downloadable List of Excluded Individuals/Entities (LEIE), who are so excluded. Anyone who hires an individual or entity on the LEIE may be subject to civil penalties. The OIG’s power to exclude is broad.

Mandatory Exclusions

Any individuals and entity convicted of a specified criminal offense must be excluded by the OIG. Those offenses include:

  • Medicare or Medicaid fraud
  • Patient abuse or neglect
  • Felony convictions for other health care-related fraud, theft, or financial misconduct
  • Felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances

Permissive Exclusions

In addition to the mandatory exclusions just noted, OIG has substantial discretion to exclude individuals and entities on a number of other grounds, including:

  • Misdemeanor convictions related to health care fraud other than Medicare or a State health program
  • Fraud in a program (other than a health care program) funded by any Federal, State or local government agency
  • Misdemeanor convictions relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances
  • Suspension, revocation, or surrender of a license to provide health care for reasons bearing on professional competence, professional performance, or financial integrity
  • Submission of false or fraudulent claims to a Federal health care program
  • Engaging in unlawful kickback arrangements
  • Defaulting on health education loan or scholarship obligations
  • Controlling a sanctioned entity as an owner, officer, or managing employee

Effects of Exclusion

The most important effect of exclusion i.e., being included on the LEIE is that payment for anything that an excluded individual furnishes, orders, or prescribes is prohibited.

Search LEIE With Every New Hire

Because the exclusion extends to anyone or any entity that hires the excluded person, it is vital that any Detroit area hospice operator search the database at the time of any new hire. A hospice operator who employs an excluded individual to provide items or services that are reimbursed by Federal health care program funds will be required to pay back 100 percent of the funds improperly received, and may also be subject to liability under the Civil Monetary Penalties Law.

Aggressive Counsel is Important to Protect Your Rights

Has your Detroit area hospice facility been threatened with inclusion on the LEIE by the Office of Inspector General? Do you have effective controls in place to monitor the LEIE? Has your hospice facility been subpoenaed or is it otherwise under investigation? A great deal is at stake and there is no substitute for an aggressive defense. Your financial future could be on the line. The Criminal Defense Firm has successfully represented clients in all sorts of federal fraud proceedings, including Medicare and Hospice Fraud. Among the firm’s attorneys are former federal prosecutors who understand the system and what it takes to develop a successful defense strategy. The Criminal Defense Firm is a team of lawyers and courtroom warriors. It has the resources to provide the best defense possible. If you choose to work with us, we will use our decades of experience to help protect your vital interests. To start building your defense today, call 866-603-4540 or contact us online now.

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