SD Medicaid Fraud Control Unit & SDAHO – Working Together

On August 27, 2020, the South Dakota Office of Attorney General’s Medicaid Fraud Control Unit (MFCU) entered into a Settlement Agreement and an Integrity Agreement with a South Dakota assisted living facility to resolve allegations that the assisted living facility hired and employed an excluded person in violation of the Office of Inspector General (OIG) Exclusion List provisions. The facility paid $1464.85 as part of the Settlement Agreement, and the facility agreed to participate in training, and to revise hiring and employment practices as part of the Integrity Agreement.  Both Agreements are public documents.

Assisted living facilities, and all health care facilities, are required to comply with provisions regarding the hiring and employment of excluded individuals. Assisted living facilities can easily avoid problems by complying with OIG Exclusion List provisions (see Overview below).

Please visit oig.hhs.gov/exclusions for further information, or contact SD MFCU at 605-773-4102 if you have questions or concerns.

Overview of OIG Exclusion List

The US Department of Health and Human Services – Office of Inspector General (OIG) has the authority to exclude individuals and entities from Federally funded health care programs. OIG maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals/Entities (LEIE). The LEIE is open to the public and is available in two formats:

  1. The Online Searchable Database enables users to enter the name of an individual or entity and determine whether they are currently excluded. If a match is made on an individual, the database can verify with an individual’s Social Security Number (SSN) that the match is unique.
  2. The Downloadable Database enables users to download the entire LEIE to a personal computer.

Any person or any entity who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP). To avoid CMP liability, health care entities need to routinely check the LEIE to ensure that new hires and current employees are not on the excluded list.

Interested in learning more?

SDAHO invites you to join a discussion on Thursday, November 5, where Paul Cremer from the South Dakota Medicaid Fraud Control Unit will discuss various healthcare matters relating to provider fraud, abuse, neglect and financial exploitation, and the OIG exclusion list.  The Medicaid Fraud Control Unit will share specific case studies of fraud and abuse committed by SD healthcare facilities and provide tips on how to prevent and avoid similar incidents from occurring.  Click here to register and learn more.