OIG Exclusions List + affect on nurses ability work

Home Health Columnist / Guide · Dec 2, 2009

office of inspector general (oig) exclusions list

for many years the congress of the united states has worked diligently to protect the health and welfare of the nation's elderly and poor by implementing legislation to prevent certain individuals and businesses from participating in federally-funded health care programs. the oig, under this congressional mandate, established a program to exclude individuals and entities affected by these various legal authorities, contained in sections 1128 and 1156 of the social security act , and maintains a list of all currently excluded parties called the list of excluded individuals/entities.
bases for exclusion include convictions for program-related fraud and patient abuse, licensing board actions and default on health education assistance loans.
http://oig.hhs.gov/fraud/exclusions.asp

what is the effect of an exclusion?

special advisory bulletin on the effect of an exclusion.

types exclusions: http://oig.hhs.gov/fraud/exclusions/authorities.asp

in a nutshell:

all health care employers are required to check oig website upon hiring for " oig sanction imposed/exclusion". any conviction for medicare/medicad fraud, defaulting on govenement student loans, and some licensing board actions especially involving drug diversion/drug sales and patient abuse will prevent one from being hired in a facility receiving funding from medicaid, medicare or other government programs once placed on this list. this several limits job opportunities when unable to pass "sanction clearance/check"

see: online searchable database if your name is listed.

LilRedRN1973 · Dec 2, 2009

This was a big issue in the dialysis clinics in my area. Another nurse in recovery was put on "leave" until the issue was cleared up due to the large number of Medicare patients dialysis sees. He was able to return within about a month after clearing his name from the list. Since I was working in a dialysis facility as well (at that time), I checked the list but didn't see my name.

debnky · Dec 4, 2009

Excellent information. Thank you. I pray I do not have to jump through that hoop. I think I am researching too much. I am imagining a lot of what if's.

sarasidnic · Dec 23, 2009

In the year 2000 it was decided that if a nurse has any issues with her nursing license including "surrender" the state board must report to AG office who in turn submits the info to the OIG. If you lose your license for a period of time but does have it reinstated by your state board you must submit documentation of reinstatement from your state board in order to apply for removal of your name from the exclusion list which san take from one week to a year. Once your name is removed, you are deemed elegible for employment. However, until your name is removed from that list you can't even sweep floors in a building that acccepts federal funds. If you do gain employment somehow while on that list you and the facility could be in serious trouble.

LilRedRN1973 · Dec 23, 2009

I've checked that list periodically since surrendering my license and so far, I've not turned up on it. Do people get "skipped" over occasionally? Should I worry about it? I work in a facility that is state run and we have a fair amount of Medicare clients (although not nearly as many as when I worked Dialysis).

SWS RN, ASN, RN · Dec 24, 2009

The above posts give a good explanation of how one gets placed on the list. I would like to share my experience. First of all, it took a very long time for me to appear on the list from the time of the "occurance" (which I will not go into here and now) until the facility I was working in was notified and subsequently notified me. Of course I had to stop working. I called the AG's office and found I could appeal. I did exactly what was asked and I was totally truthful. I had many people, supervisors, friends etc. write letters attesting to my good character and to the fact that I would not try to defraud Medicare in any way. I also sent a copy of the addictionogist's report and documentation that I had notified the Fl. IPN and was starting the process of generating a contract. The agency did not care about the particulars....anyway, I called the lead attorney weekly. She was very pleasant and helpful. The case is sent to the next level and then is reviewed. I was removed from the OIG list and sent a letter stating such as the list was to be updated about 2 weeks later, the letter was proof.

The whole process took about 8 weeks. I hope this helps. It was tedious and I did have to jump through alot of hoops, but the govt does not fool around. I did find the AG office to be much more helpful than I ever thought it would be.

Good luck...you just have to do whatever they tell you to do whether you think it's fair or not.

SWS

LilRedRN1973 · Dec 26, 2009

It's been 18 months and no sign of my name on the list. Should I contact the AG and ask them about it? I certainly don't want it to be a surprise and have it look as though I was keeping something from my employer.

SWS RN, ASN, RN · Dec 26, 2009

I guess I am a little confused, did you actually have sanctions on your license? Are you in an IPN program? or are you just concerned because you have a friend in dialysis in recovery and that happened to him? The occurance that I was involved with happened in another state and in 2001. I did not find out about the OIG list until May of 2009...I had worked in several different areas and it did not come out. I had no idea what it was when I was informed. I don't know when my actual name was placed on the list. I would not divulge any information to anyone if your name is not on the list. If however, there is something going on with your license, or you are in a contract with an IPN program then obviously your employer should know about that. I am not sure we are talking about the same situation.

I hope I did not confuse the issue more!

SWS

LilRedRN1973 · Dec 28, 2009

I surrendered my license June 2008 and am on a monitoring contract with my state. I am not allowed to work in certain areas (home health, ER, critical care, etc.), cannot pass narcotics for a year, must attend nurse support group for 5 years, call in daily for drug testing for 5 years, attend Aftercare for a year, individual counseling for a year, and attend 12 step meetings twice a week for 5 years. I also cannot work night shift during the 5 years of my contract. My employer is aware of all these restrictions as my supervisor must fill out a monthly report on my progress and I had to get prior approval before accepting the job. Is that what you were asking when you inquired about sanctions?

SWS RN, ASN, RN · Dec 29, 2009

Yes! That is the exact same contract that I have...I only began mine about 5 weeks ago...again, this stems from an incident in 2001! But I have to play the game in order to work. I don't think that I am not allowed to work night shift as long as there is a house supervisor on...other than that, its the same. I was fortunate though, I just began working for a case management firm, NO patient contact at all. I may miss ICU and PICU but it's nice to not have to think twice about finding someone to pass your narcs. The other bummer is that I have worked 7p-7a for just about my entire career. I am so used to 3 nights and out, working 5 days a week gets getting used to--however, no weekends, no holidays and no call. So it's a trade off.

About the OIG list. I am not sure if they automatically place you on it if you are in a monitoring program. I was on the list b/4 the IPN contract. So, I guess just keep checking the list for your name. If you dont know if you're on it, then your employer would not know either. Again, I dont know exactly when my name made it to the OIG. It was a long long time from the time of the incident. But if worse comes to worse, you can get yourself off the the list. As I said, I had people write letters, sent the addictionologists report and bascially informed them that I was calling the IPN. I think the biggest thing the gov't is concerned about is Medicare fraud which is what the OIG was set up for. I don't know how licensing issues ended up on the list.

ANYAY--GOOD LUCK...what state are you in?

SWS

LilRedRN1973 · Dec 29, 2009

I'm in Nevada.