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CodeMap® 05/21/2014: Screening Employees and Customers CodeMap®-05/21/2014: Screening Employees and Customers Archive

CodeMap® Compliance Briefing: May 21, 2014


Editor's Welcome:

This past week, the OIG published proposed regulations concerning new Civil Monetary Penalties (CMPs) created by the Affordable Care Act. The proposed regulations are a reminder of the significant fines and penalties providers may face if they engage in conduct that is prohibited by CMPs such as employing excluded individuals and submitting claims for services ordered by excluded individuals. Last year, the OIG also discussed the consequences of interacting with excluded individuals in a Special Advisory Bulletin published on May 8, 2013. Subscribers may access that bulletin by clicking here. Today, we are going to revisit the many compliance issues of both employing and accepting orders from excluded individuals. We will also recommend best practices to avoid the resultant liability and strengthen your compliance program.

Sincerely,

Gregory Root, Esq.


Screening Employees and Customers

by: Gregory Root, Esq.

gbroot@codemap.com

Background: OIG Exclusion

Almost thirty years ago, Congress enacted the Medicare and Medicaid Patient and Program Protection Act of 1987. That legislation granted the OIG exclusionary powers to help the agency combat fraud and abuse and better safeguard the Medicare and Medicaid programs. Since 1987, Congress has enacted further legislation several times that strengthened and expanded the OIG's power to exclude individuals and entities from participating in federally funded health care programs. In the 2013 bulletin mentioned earlier, the OIG explains that,

"The effect of an OIG exclusion is that no Federal health care program payment may be made for any items or services furnished (1) by an excluded person or (2) at the medical direction or on the prescription of an excluded person."

Liability for Organizations that Employ Excluded Individuals

Federal law also authorizes the imposition of a civil monetary penalty of $10,000 for each claim against providers that employ and/or contract excluded individuals to provide items and services covered by Medicare and Medicaid. The same laws provide for an assessment of up to three times the amount of the claim. In addition, the organization that employs/contracts with excluded individuals could face exclusion itself from participation in federally funded health care programs.

Liability for Organizations that Perform Tests and Services Ordered by Excluded Individuals

The OIG states the following in its 2013 bulletin,

"Many providers that furnish items and services on the basis of orders or prescriptions, such as laboratories, imaging centers, durable medical equipment suppliers, and pharmacies, have asked whether they could be subject to liability if they furnish items or services to a Federal program beneficiary on the basis of an order or a prescription that was written by an excluded physician. Payment for such items or services is prohibited. To avoid liability, providers should ensure, at the point of service, that the ordering or prescribing physician is not excluded."

Providers that submit claims for services ordered by excluded individuals may face liability under the Civil False Claims Act, as well as CMPs. Please remember that the Civil False Claims Act provides for penalties as high as $11,000 per claim.

To avoid the significant sanctions listed above, clinical laboratories should include rigorous screenings as part of their compliance programs.

OIG Screening Website

To aid providers in determining if an individual or organization has been excluded, the OIG maintains the List of Excluded Individuals and Entities (LEIE). Providers may access the LEIE via either a searchable online database or downloadable data files. Both may be found by clicking here. The online database presently contains the following information:
  • the name of the excluded person at the time of the exclusion
  • the person’s provider type
  • the authority under which the person was excluded
  • the State where the excluded individual resided at the time of exclusion or the State where the entity was doing business
  • a mechanism to verify search results via Social Security Number. This is useful if the person being screened has a common name such as John Smith.
Screening Policies and Procedures: Employees 
 
Most providers screen prospective employees to ensure the applicant is not excluded. In addition, many provider organizations screen all existing employees on an annual basis to ensure their workforce is able to participate in federally funded health care programs.
 
To determine which employees and contractors should be screened, the OIG recommends that provider organizations assess each and every job category or contractual relationship individually. If that job or contract involves the provision, either directly or indirectly, of any item or service that is payable by a federally funded health care program, the individual fulfilling that position should be screened. Although no law or regulation explicitly requires providers to screen employees, the OIG recommends screening employees before they are hired, and thereafter on a regular periodic basis. Also, the OIG includes employee screening requirements in almost every Corporate Integrity Agreement it writes for providers and organizations that settle out-of-court for allegations of wrong-doing. The 2013 OIG bulletin offers the following guidance concerning employee screening:
 
Concerning documentation, the Bulletin states the following:
 
"When checking the LEIE, providers should maintain documentation of the initial name search performed (such as a printed screen-shot showing the results of the name search) and any additional searches conducted, in order to verify results of potential name matches."
 
Concerning how to screen employees, the Bulletin states,
 
"We recommend that providers use the LEIE as the primary source of information about OIG exclusions because the LEIE is maintained by OIG; is updated monthly; and provides more details about persons excluded by OIG than GSA’s SAM."
 
In past settlement agreements and Corporate Integrity Agreements the OIG has required providers to screen employees against both the LEIE and the list maintained by the General Service Administration (GSA). The Bulletin appears to lessen these requirements by allowing providers to only query the LEIE.

Screening Policies and Procedures: Customers

Previously, not many provider organizations screened their customers as well as their employees. However, we are hearing from more and more subscribers that their organizations have begun this practice to protect against the significant liability that results from submitting claims to Medicare for services ordered by excluded customers. Last year's OIG Bulleting also prompted many organizations to begin screening customers. We agree that this is a prudent practice, however, we also recognize that such a compliance effort may require significant time and resources. One way to control these costs may be to limit the number of customers the organization screens. For example, a laboratory may choose to only screen customers that have ordered tests in the past 1, 2, or 5 years. Such a limit will greatly reduce the number of individuals and/or organizations that must be screened. Likewise, a laboratory may choose to only screen customers that order more than a set number of tests annually or whose orders represent a minimum threshold of revenue/reimbursement.

Until the OIG publishes updated compliance guidance for clinical laboratories, our subscribers do not have any set and/or specific rules as to how they should screen customers. However, just because such bright line rules do not exist, does not indicate that providers should ignore the potential liability of not screening customers.


 

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CodeMap Compliance Briefing: 09/23/05: Drafting Compliance Policies
09/16/2005 2006 Lab Codes and Proposed Payments
09/09/2005: LIS and Medical Necessity
08/19/2005: Lab Tests on the 2006 Physician Fee Schedule
08/05/2005 Coding Bone Marrow and Bone Biopsies
CodeMap Compliance Briefing 07/22/05: Coding Antibody and Antigen Assays II
07/08/2005 Coding Antibody and Antigen Assays: I
06/24/2005 Resubmitting Denied Medicare Claims
06/17/2005 Diagnosis Coding Rules-Part 2
05/20/05 Diagnosis Coding Rules Part 1
05/13/2005 Reflex Manual WBC Differentials
05/06/2005 Incident To Services
04/29/2005 CMS Manuals
04/22/2005 Reflex Testing
04/15/2005 Custom Panels
04/08/2005 Medicare Administrative Contractors (MACs)
04/01/2005 Place of Service (POS) Codes
03/18/2005 Subscriber Questions
03/11/2005 Medically Unbelieveable Edits
03/04/2005: Final Hospital Compliance Guidance 4
02/25/2005: Final Hospital Compliance Guidance 3
02/18/2005 Final Hospital Compliance Guidance 2
02/11/2005 Final Hospital Compliance Guidance
02/04/2005 Final Diabetes Screening Rules
01/28/2005 Medicare Appeals II
01/21/2005: Medicare Appeals I
01/14/2005 Providing Services to SNFs
01/07/2005 Medicare Errors
12/17/2004 Year End Subscriber Questions
12/10/2004 Coding Flow Cytometry Services
12/08/2004 Alert: 2005 CodeMap Manual Production Schedule
12/03/2004 Diabetes Screening Tests
11/22/2004 Announcing CodeMap Data Files
11/19/2004 Flow Cytometry Coding and Reimbursement
11/12/2004 New Venipuncture Rules
11/05/2004 Medicare Cardiovascular Screening Benefits
10/29/2004 Subscriber Questions
10/22/2004 Genetic Testing Modifiers
10/15/2004 Coding Glucose Tests
10/08/2004 Shared Laboratories
10/01/2004 Stark II and POLs
09/24/2004 New CPT Codes for Pathology Services
09/17/2004 New CPT Codes for Lab Services
08/27/2004 SNF Consolidated Billing Exceptions
08/20/2004 The OIG Exclusion Program
08/13/2004 Medicare Initial Preventive Physical Exam
08/06/2004 New Medicare Coverage for Screening Tests
07/30/2004 Discounts to Financially Needy Patients
07/23/2004 Date of Service for Lab Tests
07/16/2004 New CPT Codes for 2005
06/25/2004 Updates to NCDs and LMRPs
06/18/2004 New Compliance Program Guidance for Hospitals II
06/11/2004 New Compliance Program Guidance for Hospitals II
06/04/2004 Annual Physician Notices
05/21/2004 Screening Pap Smear Coverge
05/14/2004 Transfusion Medicine Codes II
05/07/2004 Transfusion Medicine Codes I
04/23/2004 Anti-Mark-Up Controversy
04/16/2004 Subscriber Questions
04/09/2004 Genetic Testing Codes II
04/02/2004 Genetic Testing Codes I
03/26/2004 Laboratory Marketing Practices III
03/19/2004 Laboratory Marketing Practices II
03/12/2004 Laboratory Marketing Practices I
03/05/2004 Medicare Payment for CLIA Waived Tests
02/27/2004 Medicare Payment for ReferredTests
02/20/2004 Grace Period for CPT Codes Eliminated
02/14/2004 CCI Edits Associated with New Lab and Pathology Codes
02/06/2004 CCI Edits Associated with New Radiology Codes
01/30/2004 Venipunctures
01/23/2004 The Medicare Prescription Drug, Improvement, and Modernization Act of 2003
01/16/2004 Travel Allowances
12/19/2003 Medicare Modernization Act
12/12/2003 Medicare Reform Bill Part 2
12/05/2003 Medicare Reform Bill Part 1
11/21/2003 New HCPCS Codes for CBCs without Platelets
11/07/2003 GA, GY and GZ Modifiers
10/31/2003 Specimen Collection
10/24/2003 Coding Qualitative Drugs-of-Abuse Tests
10/17/2003 The OIG's Work Plan, Medicare CDs, Recent Enforcement Actions.
10/10/2003 ESRD Composite Rate Lab Tests
10/03/2003 End Stage Renal Disease (ESRD) Reimbursement for Automated Tests
09/26/2003 Proposed Rules from the OIG
09/12/2003 Category III (Tracking) CPT Codes
09/05/2003 New Proposed Rules for Flow Cytometry
08/15/2003 Thyroid Testing
08/01/2003 CMS Lab Reimbursement Meeting
07/25/2003 NCD Misconceptions
07/18/2003 The -GZ Modifier
07/11/2003 Screening Mammogram Codes
06/27/2003 Correct Coding Edits II
06/20/2003 Correct Coding Edits I
06/13/2003 Diagnosis Coding Rules II
06/06/2003 Diagnosis Coding Rules I
05/23/2003 Revised Medicare Appeals Provisions II
05/16/2003 Revised Medicare Appeals Provisions I
05/09/2003 Business Associates Agreements
05/02/2003 Pathologist Interpretation of Clinical Lab Tests
04/25/2003 TC Billing of Pathology Services
04/18/2003 Medicare Reimbursement for Pathology Services
04/11/2003 How to Respond to a Search Warrant
03/28/2003 How to Respond to Subpoenas
03/21/2003 How to Respond to Investigators
03/14/2003 Mandatory Claim Submission
03/07/2003: Who Can Order Diagnostic Tests?
02/28/2003 Changes in 2003 Physician Fee Schedule
02/21/2003 Medical Necessity Requirements for Chemistry Panels, Part II
02/14/2003 Medical Necessity Requirements for Chemistry Panels I
02/07/2003: ABNs and Client Cooperation
01/31/2003: Patient Ordered and/or Performed Testing
01/24/2003: The Beneficiary Anti-Kickback Statute
01/17/2003: Significant Changes in 2003 Medicare Reimbursement
01/10/2003: 2003 Medicare Lab and Physician Fee Schedules
12/13/2002: More National Coverage Policies
12/06/2002: How Medicare Sets Fees for New CPT Codes
11/22/2002: Critical Year End Dates
11/15/2002: 2003 Medicare Laboratory Fee Schedule
11/08/2002: Stark Self-Referral Prohibitions
11/01/2002: Using Modifiers -59 and -91
10/25/2002: Introduction to Privacy Regulations
10/18/2002: New Codes for Obstetrical Ultrasound
10/11/2002: National Coverage Determinations (NCDs)
10/04/2002: Implementing a Radiology Compliance Program
09/27/2002: New 2003 Lab CPT Codes
09/20/2002: Automated Order Entry
09/13/2002: National Coverage Policy for Lipids
09/06/2002: The Anti-Kickback Statute
08/23/2002: Using the New ABN Forms
08/16/2002: Advance Beneficiary Notices
08/09/2002: Medicare Coverage for PET Scans
08/02/2002: Reflex Testing
07/26/2002: 2003 Hematology CPT Code Changes II
07/19/2002: 2003 Hematology CPT Code Changes I
07/12/2002: Direct Billing Rules II
06/28/2002: Direct Billing Rules I
06/21/2002: Medicare Reimbursement for Lipid Panels
06/14/2002: Bone Density Studies
06/07/2002: CLIA Waived Testing Rules
05/31/2002: Blood Draws and the Anti-kickback Statute
National Coverage Determination (NCD) Updates
05/01/2002 - CodeMap® Quarterly Reports, Volume I, No. 2
01/15/2002 - CodeMap® Quarterly Reports, Volume I, No. 1