Understanding Exclusions from Participation in Federal Health Care Programs
Overview:
OIG was established in the U.S. Department of Health and Human Services (Department) to identify and eliminate fraud, waste, and abuse in the Department's programs and to promote efficiency and economy in Departmental operations. OIG carries out this mission through a nationwide program of audits, inspections, and investigations. In addition, the Secretary has delegated authority to OIG to exclude from participation in Medicare, Medicaid, and other Federal health care programs Persons that have engaged in fraud or abuse and to impose civil money penalties (CMPs) for certain misconduct related to Federal health care programs.
The effect of 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.
The exclusion and the payment prohibition continue to apply to an individual even if he or she changes from one health care profession to another while excluded. This payment prohibition applies to all methods of Federal health care program payment, whether from itemized claims, cost reports, fee schedules, capitated payments, a prospective payment system or other bundled payment, or other payment system and
Applies even if the payment is made to a State agency or a person that is not excluded.
Why should you attend: Balanced Budget Act authorized the imposition of CMPs against providers that employ or enter into contracts with excluded persons to provide items or services payable by Federal health care programs. This authority parallels the CMP for health maintenance organizations that employ or contract with excluded individuals.
If a health care provider arranges or contracts (by employment or otherwise) with a person that the provider knows or should know is excluded by OIG, the provider may be subject to CMP liability if the excluded person provides services payable, directly or indirectly, by a Federal health care program. OIG may impose CMPs of up to $10,000 for each item or service furnished by the excluded person for which Federal program payment is sought, as well as an assessment of up to three times the amount claimed,
and program exclusion.
A provider could be subject to CMP liability if an excluded person participates
in any way in the furnishing of items or services that are payable by a Federal health care program. Attend this webinar to learn what you can to do to avoid unnecessary penalties.
Areas Covered in the Session:
- Statutory Background
- Effect of an OIG exclusion
- Violation of OIG Exclusion By An Excluded Person
- What are the different types of exclusions
- CMP Liability For Employing or Contracting With an Excluded Person
- How to Determine Whether a Person Is Excluded
- How to Limit Liability for a Violation
Who Will Benefit:
- Administrators
- Chief Executive Officers
- Chief Financial Officers
- Compliance Officers
- Individuals who work in the Healthcare Industry
- Therapists
Speaker Profile
She establishes compliance department operations to include planning, designing, and implementing system-wide Corporate Compliance and HIPAA/HITECH Programs. She writes Codes of Ethical Conduct and compliance policies and procedures for providers.
In a previous position, Dr. Freville assisted with the design and management of a company-wide infrastructure to support a Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services with clinical and financial components.
In addition, she was a Senior Medicare Auditor and has over 14 years experience as Directors of Finance, Accounting, and Reimbursement in home health, hospital, pharmacy, and long-term care. In addition, she was a healthcare Compliance Officer for 13 years. Dr. Freville retired from the U.S. Army Reserve as a Command Sergeant Major.
Dr. Freville earned a doctorate in Human Services with a specialization in Health Care Administration from Capella University. In addition, she earned a Master of Business Administration from Webster University, a Bachelor of Science in Accounting from Arizona State University, and is certified in Health Care Compliance (CHC) and Health Privacy Compliance (CHPC). Additionally, she is a member of the Health Care Compliance Association, Louisville Armed Forces Committee and Federal Bureau of Investigation Citizen Academy Alumni.