The owner of an Ohio home healthcare company, who was already on the Office of Inspector General’s (OIG) exclusion list, pleaded guilty in US District Court on June 11, 2024, to fraudulently billing more than $8.5 million to Medicare, Medicaid, and Veterans Affairs home healthcare programs between 2015 and 2021.
The defendant admitted that, when she started the home healthcare company in 2015, she concealed her ownership of the company because she had a prior felony conviction in 2013 for passing forged and fraudulent prescriptions for oxycodone and hydrocodone while serving as a nurse practitioner in Warren County. The conviction made her ineligible to participate in federal healthcare programs for ten years.
According to court documents, the company routinely overbilled federal healthcare programs, charging them for services it did not perform. In one example cited in court documents the company continued to bill Medicaid for home health services while the patient was hospitalized.
In addition, between 2017 and 2020, the company hired over 50 employees with significant criminal histories which ordinarily should have excluded them from providing home health services, including one individual who was charged with a quadruple murder while ostensibly working for the company.
The defendant submitted at least 92,770 claims to Medicaid seeking $8,556,776.58, receiving $8,403,299.24 between 2016 and 2021.
Compliance Perspective
Issue
Healthcare settings are required to conduct extensive background checks on all employees. These should be comprehensive in order to ensure that each potential employee is qualified and permitted to be employed in a healthcare facility that receives government funds. Before an employee is officially hired into a position, a criminal background check and sex offender registry search must be completed, and the individual must be cleared in the databases. Additionally, an identification verification check, past employment history, education verification, and OIG’s List of Excluded Individuals and Entities (LEIE) check must be completed for all employment candidates. For positions that need certifications or licenses, verification of these credentials must be conducted and documented in the individual’s personnel file. If criminal convictions are disclosed by the applicant, the facility should follow up with the individual to gather additional information. After hire, it is essential that the databases are continually monitored to ensure that no current employee has recently been placed on an exclusion list or had a license or certification suspended or revoked. Routine monitoring will ensure that employees are legally permitted to practice healthcare in your facility.
Discussion Points
- Review policies and procedures for verifying the status of professional licenses, including confirming that they are not included on a state or OIG exclusion list. Update as necessary.
- Train appropriate staff to follow protocols for verification of licenses and certifications of employees at the time of hire and on an ongoing basis to ensure that those licenses remain up to date and are unencumbered. Ensure that training is provided to licensed personnel about their responsibility to maintain an active license and to notify administration should their license be suspended, expire, or if they are added to the OIG’s LEIE or a state exclusion list.
- Periodically audit to verify that the licensing and certifications of employees are valid and up to date and that OIG LEIE checks are routinely conducted. Immediately address any negative findings. Also periodically perform audits to ensure all staff are aware of the importance of identifying compliance and ethics concerns and their responsibility to report them to their supervisor, the compliance and ethics officer, or via the anonymous hotline.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
