OIG issues new guidance for nursing homes on hiring people excluded from Medicare and Medicaid

Share this content:

Nursing homes can now refer to newly updated government guidelines on hiring or contracting with people excluded from participating in federal health programs. 

The issue is important for long-term care facilities, where excluded individuals often are hired in non-caregiving roles, according to Susan Gillin, deputy chief in the Administrative and Civil Remedies Branch of the Department of Health and Human Services Office of Inspector General (OIG).

“We see a lot of employment of excluded individuals in nursing homes,” Gillin told McKnight's. HHS has received many questions on the issue from nursing home operators, she added.

The OIG released the “Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs” today, marking the first update of the guidelines since 1999.

Certain individuals, such as those convicted of healthcare fraud and abuse, are excluded from participating in federal health programs such as Medicare and Medicaid. Since the 1999 guidelines on exclusion came out, OIG's authority in this area has been modified and expanded by legislation such as the Affordable Care Act.

“The effect of an OIG exclusion is that no federal healthcare 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 guidelines state.

Nursing home operators should be aware that they face potential fines and removal from the Medicare and Medicaid programs if an excluded person is providing goods or services at the facility. This includes items or services unrelated to direct patient care, including in administrative, health information technology and human resources roles. Even a temporary worker or a volunteer is not allowed to be an excluded person.

For the first time, the guidelines include a recommended timeframe for checking the List of Excluded Individuals and Entities online database. Providers are encouraged to check the LEIE monthly to limit their potential liability, and to use the OIG self-reporting process if any issues are discovered.

Click here for the new guidelines. A previously issued guidance document for nursing facilities is available here, and a 2008 supplemental guidance is available here.