QUESTION:
We just discovered that a Licensed Practical Nurse was excluded from participation in all federal health programs.  We have never had a problem with this LPN and since she is an LPN, she does not refer patients to the hospital.  Should we do anything?

ANSWER FROM HORTYSPRINGER ATTORNEY HENRY CASALE:
Yes.  First, remove this person from any contact with patients whose care is paid for in whole or in part by a federal health care program such as Medicare or Medicaid.  Next, review your employment-related credentialing process.  All employees should be screened against the OIG’s List of Excluded Individuals/Entities before they are hired.  Find out how and why this did not occur before this person was hired and institute the processes necessary to prevent a similar situation from occurring in the future.

Now for the difficult and painful part.  You need to make a voluntary disclosure to the OIG.  The information described above will help to structure that self‑disclosure.  The fact that the excluded individual was an LPN, and that an LPN does not refer patients to the hospital or other facility, is irrelevant to the OIG.  Their position is that this person should never have provided any care, items, or services to a federal health care program patient.  As a result, the OIG will demand a refund for all federal health care reimbursement received by the hospital for each patient cared for in any way by the excluded person.

As you can imagine, the penalty will add up.  For example, in January 2025, an Ohio Skilled Nursing Facility entered into a $243,000.90 settlement agreement with the OIG in order to resolve allegations that the SNF employed an LPN who was excluded from participating in any federal health care programs and who provided items or services that were billed to federal health care programs.

If you have a quick question about this, e-mail Henry Casale at hcasale@hortyspringer.com.