Policy Regarding Ineligible Persons

Objective

To ensure that the University does not employ or engage as contractors any individuals or entities who are excluded from participation in Federal or State health care programs (Ineligible Persons).

Policy

CUIMC (Columbia University Irving Medical Center) will not employ, execute contracts with, and provide items or services at the direction or prescription of, or use services provided by, ineligible persons.

The Federal and state governments, primarily through OIG and OMIG have the authority to exclude individuals and entities who have engaged in fraud or abuse from participation in Medicare, Medicaid, and other Federal and State health care programs. Exclusion from participation means that no payment may be made by those programs for any items or services furnished, directed, or prescribed by an excluded person.

The prohibition against program payment also extends to payment for administrative and management services not directly related to patient care, but that are a necessary component of providing items and services to program beneficiaries. For example, this would include payment of the salary of a billing employee who has been excluded.

Health care providers or entities that employ or enter into contracts with excluded individuals or entities for the provision of items or services to program beneficiaries may be subject to civil monetary penalties in excess of $10,000.00 for each item or service furnished by the excluded individual or entity and listed on a claim submitted to Medicare, Medicaid and other Federal and State programs, if the health care provider or entity knows or should have known that the person was excluded. In addition, the health care provider or entity could be assessed up to three times the amount or reimbursement claimed on all services furnished or ordered by the excluded individual, and could itself be excluded from program participation.

Individuals and entities can be excluded from program participation for many reasons, including, among others, conviction of a program related offense, license revocation or suspension, and default on health education loans. Several government agencies have exclusion lists available to the public. They are OIG, OMIG, NYS OPMC, SAM formerly GSA/EPLS, and the U.S. Treasury.

Procedures

The following are required procedures for prospective new hires and current employees screening including contractors, respectively:

New Hire

The CUIMC Office for Billing Compliance screens all prospective new hires, including but not limited to, clinical staff, management and officers in the departments and administrative groups, management and ancillary staff at all sites, including Service Corporation, casual temporary employees in the clinical departments, and contractors, against exclusion lists maintained by OIG, OMIG, SAM (formerly GSA/EPLS), NYS OPMC, and the U.S. Treasury Department lists.

Upon notification of an impending new hire, the OFBC will search for the individual or entity on the above listed websites lists for any exclusion. If the search is positive, the OFBC must notify the hiring contact by email and phone call that this individual or entity may not be hired or otherwise engaged by CUIMC.

CUIMC Employees and Contractors

The OFBC oversees the monthly screening of all employees and contractors by our outside vendor against all of the following:

  • Office of Inspector General (OIG) Exclusion List
  • Office of Medicaid Inspector General (OMIG) Exclusion List
  • SAM.Gov (formerly GSA/EPLS) Exclusion List
  • New York State Office of Professional Misconduct (OPMC)
  • U.S. Treasury Department Specially Designated Nationals List

The OFBC supplies lists of all employees and contractors to an outside company for screening on a monthly basis. OFBC updated the listing with newly hired personnel on a monthly basis or when hires are made. The outside vendor screens all employees monthly against all of the above exclusion lists and websites.

The outside company returns the results on a monthly basis to the OFBC. The OFBC reviews the results, investigates any positive results and clears the employee as not the excluded person. Reports are maintained within the OFBC of all screening reports and results. Appropriate action is taken consistent with Federal, State and University policy.


 

 

Office for Billing Compliance
Policy#: OFBC 10022
Original Date of Issue: 1996
Revised: 3/22/2023
Reviewed: 3/1/2024