All You Need to Know About OIG Screening

Effect of being excluded by OIG

When an individual or an entity is excluded by the OIG, they get affected in the following way:

1.      Any federal health care program will not make any payment for any items or services furnished, ordered, or prescribed by an excluded individual or entity.

2.      Along with that, the prohibition applies to the excluded person or entity as well as anyone who employs or contracts with them. Any hospital or supplier will also be prohibited where the excluded person provides services.

3.      The exclusion will be applicable regardless of who submits the claims and also applied to all the management services furnished by the excluded person.

OIG exclusion screening

The OIG Background Check is the process of verifying that a current or potential employee is not stated as an excluded person who is prohibited from participating in any of the several federal healthcare programs.

Different types of OIG exclusions

Broadly speaking, there are two types of OIG exclusions:

·         Mandatory exclusions

Mandatory exclusions are meted out as penalties for healthcare frauds, patient abuse or any unlawful distribution of controlled substances. The OIG is legally responsible for excluding the individuals or entities convicted of such crimes for a minimum of 5 years.

·         Permissive exclusions

The permissive exclusions (with discretionary authority) are mandated as penalties under 16 different authorities. The permissive exclusions are issued due to loss of state licence to practice, failure to pay student loans, failure to provide quality care, or any one of several other misconducts.

How is an exclusion screening search performed?

To carry out the New York OIG Exclusion Search, the employer enters the candidate’s or employee’s name and date of birth into the OIG database. The database will then return a list of all the potential matches that includes the names of individuals with similar names.

The employer must then independently see to it whether or not the employee in question is the same person as the excluded individual.

Along with that, the employers are also required to see all the versions of each employee’s name such as the maiden names, and name diminutives.

How long do the OIG exclusions last?

 An individual can remain excluded for a minimum of one year to an indefinite amount of time. Also, the reinstatement process is not automatic. The excluded persons have to apply for reinstatement near the end of the exclusion period.

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