Eye Care Practice Settles with Government for Employing Excluded Individual

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On March 18, the Department of Justice (“DOJ”) and the Connecticut Attorney General announced that a Connecticut eye care practice and its owners had agreed to pay $192,699 to resolve allegations that the practice improperly employed an individual who was excluded by the Department of Health and Human Services’ Office of Inspector General (“OIG”) from federal health care programs.

According to the DOJ’s announcement, the practice employed an excluded individual as its practice administrator from Feb. 2010 through May 2021. The employee had been excluded from all federal health care programs for a prior conviction of health care fraud. During the employee’s tenure, the practice billed and sought reimbursements from federal health care programs, including Medicare, Medicaid, and TRICARE. A portion of the federal health care program reimbursements that the practice received were used to pay the excluded employee’s salary and benefits.

Connecticut’s Attorney General, William Tong, noted:

The List of Excluded Individuals exists to ensure individuals convicted of serious healthcare fraud are not entrusted with public healthcare programs in the future. It was the responsibility of this employer to check the federal list and ensure the employee was authorized to perform this work.

In its announcement, DOJ cautioned health care providers to remain vigilant in screening for exclusion status of all employees and contractors (including administrative staff in addition to clinical staff), pointing to the OIG’s guidance on employing and contracting with excluded individuals and entities.

Before hiring or contracting with any individual or entity (and regularly thereafter), health care providers should make sure to check the List of Excluded Individuals/Entities on the HHS-OIG website, the federal contractor debarment database (SAM.gov), and any applicable state-specific Medicaid exclusion lists. Health care providers often fail to routinely screen for exclusion status of vendors and administrative staff, but this settlement serves as a warning that failure to take appropriate precautions, for both clinical and administrative personnel and contractors, could prove costly.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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