When a healthcare organization is found to not be in compliance with laws or regulations, corporate integrity agreements (“CIA”) and civil monetary penalties (“CMP”) may be the unintended consequences.
Beginning in September 1999, the United States Department of Health and Human Services (“HHS”) and the Office of Inspector General (“OIG”) embarked on an initiative to prevent the submission of erroneous claims and combat fraud and abuse in the Federal health care programs through voluntary compliance efforts. Submitting a false claim, or causing a false claim to be submitted, to a Federal health care program may subject the individual, the entity, or both to criminal prosecution, civil liability (including treble damages and penalties) under the False Claims Act, and exclusion from participation in Federal health care programs.(1)
The OIG has the authority to exclude individuals and entities from Federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud. Those that are excluded can receive no payment from Federal healthcare programs for any items or services they furnish, order, or prescribe. This includes those that provide health benefits funded directly or indirectly by the United States (other than the Federal Employees Health Benefits Plan).
The OIG maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals/Entities (“LEIE”). Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (“CMP”). To avoid CMP liability, health care entities should routinely check the list to ensure that new hires and current employees are not on it.(2)