Defaulting on student loans added to watch list of offenses
NASHVILLE, TN – Under the new rules established in the Affordable Care Act, hospitals and healthcare facilities now have much greater financial exposure to provider licensing violations.
“There have always been three things that automatically put a provider on the exclusion list: felonies for fraudulent Medicare billing, patient abuse and drug-related cases,” said Michael Rosen, president of ProviderTrust in Nashville, a company which specializes in exclusion-list monitoring. “But in January 2011, that list got widened to include defaulting on a federal student loan. If a hospital unknowingly employs a doctor or nurse who has defaulted, the OIG can fine that facility $10,000 for every Medicare patient that person treated during their employment, plus up to three times the amount the organization was reimbursed by Medicare. Obviously, the fines can reach six figures in a hurry.”
Prior to 2011, most healthcare organizations checked the federal exclusion lists at the employee’s time of hire or when a provider’s license was up for renewal. Now they’re strongly encouraged to check monthly – not just the OIG and GSA exclusion lists, but for all 50 states as well.
“It’s something we used to do manually because it wasn’t so time-intensive,” said Brandon Dyson, vice president of human resources at RegionalCare Hospital Partners, which operates seven hospitals across the eastern U.S. “But with the new regulations, we had staff members at all our hospitals who were spending the majority of their time tracking the exclusion lists. The manual system got too time-consuming, and it was prone to human error. Just one mistake could have been very costly to us. That’s why we turned to ProviderTrust for a web-based solution that does ongoing monitoring of the lists and has excellent reporting tools.”
ProviderTrust continuously monitors more than 1,300 data sets. “Some hospitals check only the OIG list, but it’s very incomplete,” said Rosen. “It’s important to get the state data, too – especially in places like Memphis, which borders on three states. You could have a caregiver who’s excluded in just one of those states, and still face penalties.”
Rosen added that the OIG has received $350 million to aid its efforts in combating fraud.
“They now have the money and the manpower to come after facilities that are in violation,” he said. “The new rule applies to all seven million licensed healthcare workers in the U.S., not just to doctors and nurses. So if an occupational therapist defaults on a federal student loan, the same penalties apply. Anyone who is directly – or even indirectly – reimbursed by Medicare is under scrutiny. Recently, a long-term care facility in Indiana was fined more than $375,000 for employing kitchen workers who were on the exclusion list. That’s why constant monitoring has become so important.”
“It’s a situation that’s now on the radar of hospital CFOs,” said Matthew Haddad, CEO of Los Angeles-based Medversant, which also offers exclusion-list monitoring solutions. “In the past, employing someone on the exclusion list might have resulted in a Joint Commission audit, but it didn’t affect your bottom line. Now there are huge financial implications, and the OIG is really serious about enforcing the new rules.”