Outside Publication

Background Checks and Excluded Persons, Chapter Four, AHLA Health Care Compliance Legal Issues Manual

5th Edition

April 2019

Screening of the various federal and state exclusion and debarment databases to ensure your organization is not employing or contracting with an excluded person remains a critical compliance function. It is all the more important given the significant scrutiny and risk under the federal Civil Monetary Penalty (CMP) Law and False Claims Act (FCA) related to excluded individuals, as well as reporting obligations related to federal health care program enrollment and, increasingly, commercial payer contracts. Screening also ensures compliance with the federal law that prohibits Medicare or Medicaid billing for items and services ordered, prescribed, or furnished by an excluded individual or entity.

Health care organizations should conduct frequent screening and background checks of employees and contractors and, increasingly, best practices may give rise to screening of medical staff, vendors, board members, and, in some cases, prescribers. This chapter of the AHLA Health Care Compliance Legal Issues Manual, written by partner Howard Young and associate Jacob Harper, discusses exclusion screening and the effect of exclusion on health care providers, employee screening requirements for long term care employees who provide direct patient care, and certain relevant case law.

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