When we go to a hospital or a doctor’s office, we operate on trust. We trust that the people taking care of us are qualified, honest, and safe. But how does the healthcare industry ensure that trust is well-placed? How do hospitals know that a new nurse or billing manager hasn’t been banned from working in medicine due to fraud or abuse?
The answer lies in a process called the OIG Check.
If you work in healthcare management, HR, or own a medical practice, understanding this check isn’t just “good to know”—it is absolutely essential for keeping your doors open. Let’s break down what this means in simple terms.
Who exactly is an OIG?
The Office of Inspector General, also known as the OIG, is analogous to a “watchdog” for the United States Department of Health and Human Services. In short, OIG’s responsibility is to protect our federal healthcare programs from fraud and abuse.
When an individual commits a crime such as stealing medications, billing for services never rendered, or abusing a patient, the OIG will investigate and take appropriate action against the alleged perpetrator. If the alleged crime warrants, the OIG will prohibit the individual from being employed by any federally funded entity by placing that individual on an OIG Exclusion list.
What is an OIG Exclusion?
An OIG exclusion prohibits an individual/enterprise from engaging in federally funded healthcare programs. An OIG Exclusion is similar to a revoked driver’s license. If an individual receives multiple traffic citations, the government may revoke his/her driver’s license; however, if an individual violates patient care standards or engages in financial fraud and is placed on the OIG Exclusion list, that individual has had the equivalent of a revoked driver’s license, and cannot be compensated via any federally funded healthcare provider regardless of his/her prominence as a surgeon or receptionist.
The Importance of Conducting an OIG Background Check on Your Employees
You may be saying to yourself, “I hire good people, so this does not apply to me.” Unfortunately it is not that easy, as many people can hide their past history from you. Therefore, conducting an OIG background check on all your employees is required by law.
Here are some reasons why conducting an OIG background check on all of your employees is extremely important:
- Lawsuit Risk: If you receive government funding (such as reimbursable medication by the Medicare program) it is your responsibility to ensure that you do not employ someone on the OIG exclusion list.
- Civil Penalties: If you employ someone who is on the OIG exclusion list you may have to return to the government and pay back the full amount of wages you paid that person, as well as, facing serious financial penalties for taking federal reimbursable funds.
- Patient Care: Many people on the exclusion list have been excluded because they were found to have injured or abused a patient or controlled substance. By conducting an OIG check on all your employees, you are protecting your patients from being cared for by someone who may potentially be dangerous.
How Can You Accomplish This Task?
The OIG has set up an LEIE database (List of Excluded Individuals/Entities) where all the persons entities who are excluded from receiving any reimbursement from Medicare or Medicaid are listed.
If you check an employee or potential employee’s name against the LEIE and receive a match, you will need to verify the match using your prospective employee’s Social Security Number (SSN).
In Conclusion
The OIG check will serve as an insurance policy for your medical practice. The control of your finances, your reputation, and your patients will all be protected by running the OIG Check. By knowing what the OIG exclusion means, and by being proactive with your screening process, your healthcare facility will remain a safe haven for all.