The OIG’s Increasing Interest in Exclusion Enforcement

Exclusion Screening, LLC

Exclusion Screening, LLC, a company Robert Liles and I recently started, supplies exclusion screening services to health care providers.  As part of the business, we naturally keep track of all things pertaining to exclusion enforcement including all of the enforcement actions reported by the OIG or DOJ.

The exclusion enforcement cases reported in the 1st quarter of 2015 seemed, at first glance, to be unremarkable showing only small increases in the number of cases reported, and the CMPs imposed, and seeming to maintain the slow, steady rise of the previous years. Close examination of the cases, however, suggests strongly that the OIG is picking up the pace of exclusion enforcement, and that it may even be headed toward a national exclusion enforcement project.

Exclusion Enforce Prior to Publication of the Updated Special Advisory 

Prior to May, 2013, the time at which the OIG published its Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs (Updated Special Advisory), OIG’s involvement in exclusion enforcement principally took the form of processing self disclosures. In 2013, for instance, 82% of all exclusion cases reported on the OIG website were self disclosure cases, and the percentages in 2010 and 2011 were similar at 80% and 85% respectively.   In other words, only about 1 in 5 exclusion violation cases were investigated on front end by the OIG during this period.

OIG’s Changes Approach to Exclusion Enforcement

OIG’s publication of its Updated Special Advisory seemingly marked a change in more than policy.  In the second half of 2013, for instance, the OIG’s direct involvement in case origination and case investigations started to show signs that it was increasing, and in 2014 approximately 1/3 of the reported cases were initiated by the Agency. The first quarter of this year continues this trend, and even though the sample size is relatively small, the OIG direct investigational involvement in reported cases was 45% for the period.

Exclusion “Data Analysis Project”

Last October, the OIG press release announcing a large exclusion violation settlement gave special credit to a “Data Analysis Project” conducted by its Office of Audit Services in support of the investigation.  Such a project suggests a more proactive approach to exclusion enforcement.

This “suggestion” has gained some traction with the recent announcement of another exclusion violation settlement supported by the so-called “Data Analysis Project.”  This time, however, the Office of Evaluations and Inspections (a sister investigative agency within HHS/OIG) was given credit for the work instead of the Office of Audit Services. Whether or not these “Projects” are connected or a part of some larger initiative can’t be known at this point, but they clearly demonstrate broad based agency of exclusion screening enforcement.

Conclusions?

The number of cases are not nearly large enough to be statistically significant and no formal announcements have been made, but the OIG certainly seems poised to aggressively address Exclusion Screening violations with its increasing participation in exclusion investigations, “data analysis projects” and broad based agency support.  In such an environment, compliance with exclusion screening requirements is more critical than ever!

 

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