Healthcare Organizations Pay Over $1 Million To Settle Allegations For Employing Excluded Individuals In Second Quarter 2015

The Office of Inspector General of the U.S. Department of Health and Human Services (OIG) continues to crack down on healthcare organizations that hire or engage with excluded parties. During the second quarter of 2015 calendar year, the OIG reported on 11 cases where healthcare organization had employed at least one individual excluded from participation in federal healthcare programs. The settlement amounts from these 11 cases totaled $1,287,741.30. Listed below are synopses of these cases.

• On April 6, YCB, Inc. d/b/a Home Helpers, located in Pennsylvania, entered into a settlement agreement with the OIG, The agreement resolved allegations that between July 1, 2010 and December 12, 2011 the organization employed an excluded individual that rendered services to Medicaid recipients. Home Helpers agreed to pay $69,130.00.

• On April 7, the Consulate Health Care at the Heart of Caring self-disclosed to the OIG on behalf of its subsidiary Envoy of Richmond, LLC d/b/a Envoy of Westover Hills in Virginia. The organization disclosed it employed an excluded individual and agreed to pay $11,037.35.

• On April 27, Golden Triangle Living Centers, Inc., located in Texas, disclosed to the OIG that the organization employed an individual it knew or should have known was excluded. The organization agreed to pay $163,740.54.

• On April 27, Town Hall Estates-Arlington, Inc., located in Texas, agreed to pay $70,000 as part of a settlement agreement with the OIG. The settlement agreement resolves allegations that the organization employed a licensed vocational nurse that it knew or should have known was excluded.

• On May 6, Arastoo Yazdani, M.D., in Maryland, disclosed to the OIG that the organization employed an individual it knew or should have known was excluded. The organization agreed to pay $42,334.50.

• On May 13, Maryland Cardiology Associates, P.C. disclosed to the OIG that the organization employed an individual it knew or should have known was excluded. The organization agreed to pay $134,506.47.

• On June 1, P&S Healthcare Management, LLC entered into a settlement agreement with the OIG and agreed to pay $100,000.00. P&S Healthcare Management, LLC and Woodland Springs Healthcare, LP, its former general partner, allegedly employed one and two excluded individuals, respectively.

• On June 8, Meridian Williamsburg Acquisition Partners, LP d/b/a Williamsburg Village Healthcare Campus settled with the OIG for employing a certified nurse aide that they knew or should have known was excluded from participation and who provided services that were billed to federal healthcare programs. The organization agreed to pay $77,772.08.

• On June 19, Accurate Home Care, LLC, located in Minnesota, entered a settlement agreement with the OIG to resolve allegations it employed an excluded individual that rendered services to Medicaid recipients. The organization agreed to pay $334,651.82.

• On June 29, Safe Haven Health Care, LLC, located in Idaho, disclosed to the OIG that the organization employed an individual it knew or should have known was excluded. The organization agreed to pay $262,249.44.

• On June 30, Adam Diasti, D.D.S., P.C. entered a settlement agreement with the OIG to resolve allegations that the organization employed an excluded registered dental assistant who provided services that were billed to federal healthcare programs. The organization agreed to pay $22,319.26.

These OIG enforcement cases highlight the need for healthcare organizations to ensure they do not hire or engage with individuals who are excluded from participation in federal healthcare programs. Month after month the OIG continues to receive self-disclosures, as well as conduct their own investigations, related to excluded individuals still rendering services to federal healthcare program beneficiaries.

The only way to protect your organization is by conducting sanction and exclusion checks against the List of Excluded Individuals and Entities (LEIE) during the hiring process and monthly once the person is hired. Screening for program exclusions should be viewed by your organization, and especially by executive management, the compliance officer and the Board of Directors, as a necessary part of doing business in the healthcare industry. Individuals and businesses can be excluded for a number of reasons, i.e., offenses related to the delivery of care; patient abuse or neglect; fraud, theft and other financial misconduct; and felony convictions related to controlled substances. Therefore, to protect your business, and especially the welfare of your patients and employees, sanction screening is a necessary part of the business.