SureCheckUSA OIG Exclusion Checks. The Health and Human Services Office of Inspector General’s (OIG) mission is to detect and root out fraud in Federal health care programs, including Medicare and Medicaid. Fraud diverts scarce resources meant to pay for the care of patients and other beneficiaries.

OIG’s efforts to curb fraud include:

• Conducting criminal, civil, and administrative investigations of fraud and misconduct related to HHS programs, operations, and beneficiaries.
• Using state-of-the-art tools and technology in investigations and audits around the country.
• Imposing program exclusions and civil monetary penalties on health care providers because of criminal conduct such as fraud or other wrong doing;
• Negotiating global settlements in cases arising under the civil False Claims Act, developing and monitoring corporate integrity agreements, and developing compliance program guidance.

The number of investigations, convictions and fines collected by OIG along with state and federal law enforcement has steadily continued to rise each year. Healthcare compliance departments can be overwhelmed with performing monthly searches of all federal and state exclusion and sanction lists for employees, contract workers and vendors. Improperly billing Medicare or Medicaid for services provided in part or whole by individuals or vendors currently excluded may result in significant fines.

The Department of Justice obtained more than $3 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending Sept. 30, 2019. Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $62 billion.

Below are just a few of the recent fines or exclusions imposed on healthcare providers for filing such claims:

• June 2024 – Missouri case involving employment of an excluded individual $300,000
• February 2024 – Kentucky case involving employment of an excluded individual $184,000
• January 2024 – California case involving employment of an excluded individual $377,000
• November 2023 – Arizona case involving employment of an excluded individual $86,000
• October 2023 – South Carolina case involving employment of an excluded individual $115,000
• October 2023 – Arizona case involving employment of an excluded individual $21,000
• August 2023 – Texas case involving employment of an excluded individual $115,000
• July 2023 – Minnesota case involving employment of an excluded individual $150,000
• June 2023 – New York case involving employment of an excluded individual $866,000
• May 2023 – Ohio case involving employment of an excluded individual $77,000
• March 2023 – Illinois case involving employment of an excluded individual $213,000
• February 2023 – New York case involving employment of an excluded individual $188,000
• January 2023 – Arizona case involving employment of an excluded individual $338,000
• December 2022 – Ohio case involving employment of an excluded individual $146,000
• November 2022 – Puerto Rico case involving employment of an excluded individual $105,000
• October 2022 – Pennsylvania case involving employment of an excluded individual $405,000
• September 2022 – Rhode Island case involving employment of an excluded individual $158,000
• August 2022 – Nevada case involving employment of an excluded individual $33,000 penalty
• June 2022 – Rhode Island case involving employment of excluded individuals $325,000 fine
• May 2022 – Rhode Island case involving employment of excluded individuals $118,000 fine
• April 2022 – Michigan case physician exclusion for 3 years for submission of medically unnecessary services
• March 2022 – Ohio case involving employment of excluded individuals $765,000 fine
• December 2021 – Physician excluded for 10 years due to submitting false claims
• November 2021 – Physician excluded for 7 years due to submitting false claims
• September 2021 – Texas case involving employment of excluded individuals $247,000 fine
• August 2021 – Illinois case involving employment of excluded individuals $84,000 fine
• June 2021 – Florida company excluded for 3 years
• May 2021 – Nevada case involving employment of excluded individuals $13,000 fine
• April 2021 – Nevada case involving employment of excluded individuals $10,000 fine
• February 2021 – $50,000 fine for submitting claims while physician excluded
• December 2020 – New York case involving kickbacks individual excluded for 15 years
• November 2020 – Oklahoma case involving improper remuneration individual excluded for 10 years
• October 2020 – Florida case exclusion for 5 years and $50,000 fine
• September 2020 – California case involving excluded individual fine $85,000
• August 2020 – Maine case involving excluded individual fine $30,000
• July 2020 – Texas case involving excluded individual fine $143,000
• June 2020 – Florida practice $94,000
• May 2020 – South Carolina ambulance service $2.2M
• April 2020 – New Mexico physician and practice $199,000
• March 2020 – North Carolina ambulance service $342,000
• February 2020 – Maryland hospital $106,000
• January 2020 – Illinois physician $130,000
• December 2019 – Maryland excluded individual fine $94,000
• November 2019 – Texas case involving excluded individual fine $121,000
• October 2019 – Indiana case involving excluded individual fine $51,000
• September 2019 – Texas case involving excluded individual $53,000
• June 2019 – Illinois case involving excluded individual $125,000
• May 2019 – Tennessee case involving excluded individual $102,000
• April 2019 – Georgia case involving excluded individual $121,000
• March 2019 – Texas case involving excluded individual $171,000
• February 2019 – Ohio case involving false claims $111,000
• January 2019 – Oklahoma case involving excluded individual $96,000

**source US Dept Health and Human Services OIG

SureCheckUSA’s service provides secure automated monthly checks of federal and state exclusion and sanction data sources. These include LEIE, SAM, OFAC, FDA, Medicare Opt Out and available state exclusion lists. The SureCheckUSA service is an inexpensive way for healthcare facilities to exercise due diligence in searching exclusion and sanction lists on a monthly basis. Improper billing for services related to an excluded individual or entity is easily avoided with SureCheckUSA’s monthly OIG sanction exclusion check service. Additionally, our experienced staff perform all necessary resolutions of search results freeing up your staff’s valuable time.

Note: Any organization requesting exclusion screening services must comply with the Fair Credit Reporting Act as well as all federal, state and local statutes, regulations and rules including providing employees or employee applicants with a copy of SureCheckUSA exclusion screening results where applicable.

Call us today at 217-321-2470 or send an email to infosc@surecheckusa.com!