A Connecticut geriatric and adult psychiatry LLC and its owner have been accused of filing false claims. The allegations stem from accusations that the Connecticut psychiatry company and its owner employed a psychiatrist that was excluded from participating in all federal healthcare programs.
In 2006, the excluded psychiatrist was convicted in Florida of conspiracy to commit healthcare fraud. This conviction led to the psychiatrist being excluded from all federal healthcare programs. In February 2016, the psychiatry company and its owner hired the excluded psychiatrist as a clinical director. The excluded psychiatrist remained in that position until June 2021. While he served as the clinical director, the psychiatry company and its owner billed and sought reimbursement from federal healthcare programs, including Medicare, Tricare, and the Railroad Retirement Medicare Program. The excluded psychiatrist’s salary and benefits were partially paid for by reimbursement from the federal programs.
The psychiatry company and its owner will pay $310,874 to resolve their liability under the federal and state False Claims Acts.
Compliance Perspective
Issue
All employees prior to hire must be screened against the OIG’s List of Excluded Individuals and Entities (LEIE) here. The LEIE should also be checked on a monthly basis to ensure that no current employees have been added to the exclusion list. Placement on the LEIE excludes an individual or entity from employment in a setting that participates in federal healthcare programs, and no program payments may be made for items or services furnished by that excluded individual or entity. If claims are filed that involve the excluded individual, it can result in false claims charges, whether or not the healthcare organization was aware that the individual was on the exclusion list. Additional information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 1, Compliance and Ethics Program, CP 2.0 C – Screening and Evaluation of Associates.
Discussion Points
- Review your policies and procedures on checking the List of Excluded Individuals and Entities. Update your policy as needed.
- Train appropriate staff on your policy and procedure for reviewing the LEIE for all new hires and current staff. Document that the training occurred, and file each signed document in the employee’s individual education file.
- Periodically audit the LEIE to ensure that no current employees or consultants are on the exclusion list. Take immediate action if any are found.
