I. Closure of OIG Exclusion Loophole

The U.S. Department of Health and Human Services, Office of Inspector General’s  (HHS/OIG)  exclusion authority may be expanded to exclude certain individuals with a prior interest in sanctioned entities. U.S. House of Representative Lois Frankel introduced a bill called “The Fighting Medicare Fraud Act of 2016” on May 17, 2016. This bill will close a loophole that allows owners and officers of sanctioned providers to “slip through the cracks” and move on to new companies.  The legislation, if passed, will allow the OIG to seek the permissive exclusion of the owners, officers and managing employees of sanctioned providers.  In addition, the proposed bill provides authority for the exclusion of affiliated companies of those involved in health care fraud.

II. The Expansion of OIG Exclusion Authority

The expansion is consistent with the government’s increasing focus on individual responsibility as evidenced by the “Yates Memo” published in September of 2015.  In that memo, the Department of Justice made individual responsibility a priority and required consideration of individual consequences in each case investigated for violations of criminal or civil health care fraud in addition to any charges brought against the corporate wrongdoers.

The Medicare Fraud Act bill also addresses the sale and distribution of beneficiary identification or provider numbers. Furthermore, the illegal purchase or sale of more than two beneficiary or provider numbers could lead to a prison term of up to 15 years and a fine.

III. Conclusion

The Fighting Medicare Act of 2016 seeks to broaden and expand the OIG exclusion authority. The OIG will be able to sanction certain individuals that had a prior interest in sanctioned entities, and entities affiliated with sanctioned entities. This expansive authority will substantially impact many providers and entities requiring them to screen all individuals more effectively. If you have any questions about exclusions and your screening obligations, feel free to contact any of us at Exclusion Screening, LLC^SM. 

 Robert W. Liles, Managing Partner of Liles Parker, LLP and Paul Weidenfeld, CEO of Exclusion Screening, LLC are the Co-Founders of Exclusion Screening. Contact Robert through this link to the Liles Parker website or by phone to (202) 298-8750, or contact Paul at pweidenfeld@www.exclusionscreening.com or 1-800-294-0952 if you have any questions.