What are the fines and penalties if you have employed an excluded person or entity?

According to the OIG and regulations, the civil and monetary fines that can be imposed by the OIG is up to $10,000 per item claimed plus up to three times. Further, the claims that were reimbursed may subject you organization to the submission of a False Claim. A repeated or serious infraction can lead to your organization losing its right to bill CMS, and may result in the issuance of a Corporate Integrity Agreement with the OIG or worse being shut down.

Costs of non-compliance

  • 10K for each item/service billed
  • Fines equaling triple that of the amount paid for the services
  • Possible exclusion from federal healthcare programs

 

Recent examples of OIG exclusion fines

          Fine                                            Excluded person

$92,052.78                                                  residential counselor

$274,721.40                                               medical biller

$34,187.34                                                  x-ray technician

$207,427.34                                               certified nursing assistant

$317,660.89                                               registered nurse

$129,216.80                                               laboratory assistant

$96,259.57                                                  pharmacist

 

 

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