Exclusion from Medicare can be the ultimate punishment for healthcare workers and executives who are convicted of healthcare crimes or have their medical licenses revoked in any state. All healthcare companies, including those that provide contract nurses and doctors to hospitals, are expected to check the ever-growing exclusion list to ensure none of those people are caring for Medicare beneficiaries.
As of April, the exclusions list included not only people but 2,812 pharmacies, laboratories, ambulance firms, durable-medical equipment suppliers, medical clinics and other healthcare companies. The list is updated monthly, as some exclusions expire and new ones are imposed.
HHS' inspector general's new 20-page document, known as special advisory bulletin, compiles answers to common questions that have come up through self-disclosures and past advisory opinions and includes changes stemming from the Patient Protection and Affordable Care Act, the Balanced Budget Act of 1997 and other laws.
In particular, the document sheds light on who can work in hospitals on temporary or contract basis.
“It is a big deal to people,” said Susan Gillin, deputy chief in Office of the Inspector General's Administrative and Civil Remedies Branch. “We get a lot of phone calls from people asking who they can hire to do certain services.”
The advisory says hospitals and physician practices have the responsibility of making sure that all temporary personnel are not excluded. However, a hospital can “reduce or eliminate” potential penalties if it can show that the agency that provided the temporary workers agreed in contract to do the background screenings, according to a footnote in the rules.
Even then, hospitals have to make sure the staffing agency is doing its job, for example by requesting proof that the checks were completed every month.
Deb Zelnio, vice president of marketing at healthcare staffing firm LocumTenens.com in Alpharetta, Ga., said her company has been doing monthly background checks for all credentialed workers it sends to hospitals and clinics for more than a year. But she said the hospitals and clinics where the contract employees work do their own exclusion screening as well.
“I can't imagine that we would do it in place of the client doing it,” she said. “They do their own checks and credentialing, and what we do is above and beyond” that work.
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