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OIG Continues to Step Up Enforcement of Exclusion Violations

exclusion violation

Enforcement of exclusion violations by the Office of the Inspector General (OIG) continues to show rise with increases in both the number of cases and the size of the settlement recoveries over the first part of the year. As always, this is a trend that we will continue to keep track of.

I. Imposition of Civil Money Penalties Appear to be Increasing

One of the rising trends by the OIG this year includes an increase in the amount of Civil Monetary Penalties (CMP) imposed. In all of 2015, for instance, there were only two cases that settled for over $400,000 whereas there have already been 7 such settlements through the first week of August this year. Similarly, average settlements have increased about 20% to almost $150,000 per settlement this year.

Some of the largest cases this year have been against hospitals (including an $807,000 settlement for two excluded employees and a $545,000 penalty for just one employee), but there have also been some significant cases against physician practices. Of note, there was a $435,500 settlement against a physician practice in July for a single excluded person, and a $275,000 settlement against a cardiology practice earlier this year for having an excluded biller.

II. The Number of Exclusion Violation Settlements is “UP”

Along with the increase of settlement amounts, the number of settlements by the OIG regarding exclusion violations has risen this year. Each month this year has outpaced the previous year, and overall there has been a 50% increase in the number of settlements compared so far in 2016 as compared to a comparable period in 2015. This further demonstrates OIG’s serious commitment to enforcing exclusion screening requirements and punishing exclusion violations.

III. Conclusion

With the increase of OIG exclusion settlements and larger settlement amounts, screening employees, vendors and contractors against the List of Excluded Individuals and Entities (LEIE), the System for Award Management (SAM), and all 37 state lists every month is critical. To eliminate the risk of having to self-disclose a possible exclusion violation or endure an OIG investigation, contact the Exclusion Experts at 1-800-294-0952 or online for a free consultation.

PWeidenfeld

Paul Weidenfeld, Co-Founder and CEO of Exclusion Screening, LLC, is the author of this article. He is a longtime health care lawyer whose practice has focused on False Claims Act cases and health care fraud matters generally.