According to the OIG’s “Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse”, the OIG is legally required to exclude individuals and entities from all Federal healthcare programs who have been convicted of the following criminal offenses:
1. Medicare or Medicaid fraud or offenses related to delivery of items or services under Medicare or Medicaid.
2. Patient abuse or neglect
3. Felony convictions for other healthcare related fraud, theft or other financial misconduct
4. Felony convictions for unlawful manufacture, distribution, prescription or dispensing of controlled substances.
The OIG can also exclude on other grounds such as:
- Misdemeanor convictions related to healthcare fraud
- Misdemeanor convictions related to unlawful manufacture, distribution, prescription, or dispensing of controlled substances
- Suspensions, revocation or surrender of healthcare license for issues surrounding competence, performance, or financial integrity
- Provision of unnecessary or substandard services
- Submission of false claims to Federal healthcare program
- Participating in illegal kickback
- Defaulting on health education loan or scholarship program
Any excluded physician cannot bill Medicare or Medicaid for services rendered. In addition these services cannot be billed indirectly through an employer or group. Therefore, a physician cannot employ or contract with individuals or entities on the OIG exclusion list. Civil monetary penalties and/or repayment of services may occur upon discovery of any direct or indirect services paid for by Federal healthcare program.
To see how the LEIE could potentially impact your practice, please join us for our free January 23rd webinar at 12pm EST