Medical Journal Houston Vol. 10, Issue 10, January 2014 | Page 4

Medical Journal - Houston Page 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . January. 2014 . . . Discover our version of INTENSIVE CARE. . . . . . . . . . . . . . . . LEGAL AFFAIRS Moody National Bank Health Professionals Courtesy Account As a health professional, you and your family qualify for special care at Moody National Bank. We have bundled useful tools for business and professional clients with our most popular personal banking, trust and wealth management services so you can focus your time and talents where they are needed most. Call Tino Gonzalez, Vice President, [phone], Ext. 6380, or send an email to [email protected] for complete information. Tino Gonzalez, Vice President Moody National Bank Bank your future on our 106-year past. Convenient offices in Brazoria, Fort Bend, Harris, Travis and Galveston Counties. Visit www.moodybank.com for your nearest location. 27 Staying informed: how to avoid liability for exclusionary violations BY Mary M. Bearden and Allison Shelton, Brown & Fortunato, P.C. On May 8, 2013, the Office of Inspector General (OIG) issued a Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs (Updated Bulletin) as an update to the previously issued 1999 Bulletin. The Updated Bulletin provides guidance for the health care industry on the scope and implications of exclusions. The U.S. Department of Health and Human Services established the OIG to identify and correct problems and to ensure efficiency within the Department’s programs. In accordance with these goals, the OIG may exclude individuals or entities who have committed program-related fraud or abuse from federal health care programs. For example, if a health care provider bills Medicare for substandard or unnecessary services, then the OIG has the discretion to exclude the provider. In some situations (e.g., patient abuse or conviction of Medicaid fraud), the OIG must exclude the health care provider. Exclusion is often seen as the death knell for providers because they can neither directly provide nor indirectly participate in services billed to a federal health care program. Ironically, the OIG does not expressly prohibit excluded persons from owning a health care provider. Such ownership has certain risks, however. When an excluded person owns five percent or more of an entity, the OIG may exclude the entity from federal health care programs. Exclusions have implications for not only the excluded person but also the health care industry as a whole because other providers must take precautions not to employ or contract with an excluded person. According to the Updated Bulletin, “no Federal health care 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.” Violators, whether excluded or not, may be subject to assessments, exclusion, and civil monetary penalties (CMPs). Providers that contract with or employ excluded persons may incur CMPs up to $10,000 for each service from which payment is sought, can be subject to an assessment of three times the amount claimed, and may be excluded. According to the Updated Bulletin, provider liability arises when “an excluded person participates in any way in the furnishing of items or services that are payable by a Federal health care program.” Even if the excluded person did not receive compensation or worked temporarily with Please see LEGAL AFFAIRS page 17