Medical Journal Houston Vol. 10, Issue 10, January 2014 | Page 17

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January 2014

LEGAL AFFAIRS
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the provider through a staffing agency, the
provider is still liable.
Under the Updated Bulletin, the term,
“Federal health care program,” encompasses
any federally funded program, such as
Medicare Parts A through D, Medicaid and
other state programs, Medicare Advantage,
TRICARE, etc.
When a person is
excluded, the person cannot directly or
indirectly furnish services or items payable
under such programs, regardless of the
form of payment. Payments from federal
health care programs may include “itemized
claims, cost reports, fee schedules, capitated
payments, a prospective payment system
or other bundled payment.” Accordingly,
excluded persons may not render a service
even remotely related to patient care. In
fact, excluded persons cannot perform

administrative or managerial services for a
provider that participates in a federal health
care program. Even filling a prescription
written by an excluded person is a violation.
The OIG maintains a List of Excluded
Individuals and Entities (LEIE). The LEIE
provides details on the person or entity
excluded and allows the search to be
verified through the use of a social security
number or employer identification number.
In the future, the LEIE may be searched
by the person’s/entity’s National Provider
Identifier.
The Updated Bulletin focuses on the
proper screening steps that providers should
take in order to avoid liability. The OIG
recommends that providers regularly search
the LEIE and document the name searches
they conduct in order to verify the results of
potential matches. The OIG recommends
screening new employees and periodically
screening current employees. Providers
can decide how frequently to conduct
screening, but since the OIG updates the
LEIE monthly, the OIG advises providers
to screen monthly to minimize potential
liability.
A contractor may conduc