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Provider Employment of Sanctioned Individuals ____________________________________________________
Federal Fraud and Abuse regulations adopted by the Health and Human Services Office of the Inspector General in compliance with both HIPAA ( Public Law 104- 191 ) and The Balanced Budget Act of 1997 ( Public Law 105-33 ), identify significant civil and criminal actions that may be taken against Medicare / Medicaid providers who employ federally sanctioned individuals . This is true even if the sanctioned individual does not work directly in providing services to individuals under any federally funded healthcare program .
Contracted providers must ensure that no management staff or other persons who have been convicted of criminal offenses related to their involvement in Medicare , Medicaid , or other Federal Health Care Programs are employed or subcontracted to provide services .
If a contracting provider does employ an individual who is on the federal sanction list , and that person provided services which are directly or indirectly reimbursed by a federally funded program , the employer may be subject to legal action which could include civil penalties , criminal prosecution and / or exclusion from program participation . The contracted provider must notify Hometown Health of any violation and must remove the employee form performing any services for Hometown Health ’ s members .
It is essential that providers regularly check the federal sanction list which can be found at :
https :// exclusions . oig . hhs . gov /. All providers should check current and potential employees against the list on the federal database to ensure that no sanctioned individuals are working for their organization . Providers are to maintain documents related to their screening process and , when requested , attest to Hometown Health that no sanctioned individuals are providing healthcare services to Hometown Health ’ s members .
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