If the OIG sounds kind of ominous to you, it’s for a good reason. OIG stands for Office of Inspector General and they’re basically the FBI of the Department of Health and Human Services (HHS) programs. The official mission of the HHS is to “Enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.”
That’s a beautiful reflection. But what do they actually do?
The HHS helps with a variety of different public health programs like smoking prevention and most recently Covid-19 prevention. They also manage human services like adoption and foster care and healthcare services like Insurance, Medicaid, and Medicare. The HHS has 11 operating divisions, including some agencies you might know like the Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, and the Food and Drug Administration.
You might be wondering why the CDC and Medicare need their own FBI. The answer may surprise you if you don’t have a criminal mind. To understand why they’re needed, we need to understand what they do. The OIG is the largest civilian office with approximately 1,650 staff members and its goal is to fight waste, fraud, and abuse of Medicare, Medicaid, and more than 100 other HHS programs. The majority of its time goes toward Medicare and Medicaid because these programs represent a big part of the Federal budget and they affect the country’s most vulnerable citizens.
Just like the real FBI has to investigate someone printing thousands of fake coupons out of their garage as well as transnational organized crime groups like the Mafia, the OIG has its big and small responsibilities. For example, they make sure health organizations are following federal rules by auditing them and making changes to improve efficiency.
But they also work to investigate fraud, corruption, and embezzlement.
The OIG takes its job incredibly seriously. Not only does the OIG have a black list of “excluded individuals,” but they also have a list of 132 most wanted fugitives of health care fraud and child support fraud. One of the most wanted fugitives is Poul Thorsen who allegedly diverted over $1 million of the CDC grant money to his own personal bank account by sending invoices on CDC letterhead. He literally tried to impersonate the CDC.
Most people are on the list for scheming to defraud health insurance companies and Medicaid/Medicare by filing false claims. These people are typically trying to acquire government funds under false pretenses and sometimes end up defrauding unsuspecting people who are just trying to receive quality healthcare.
That is why healthcare providers have to keep their guards up and continuously scan the OIG excluded persons list to make sure they aren’t hiring or working with people or organizations that have failed to adhere to federal guidelines.
Keeping up with exclusion checks can be its own massive project. There are guidelines for how to screen and how often it should be done. This usually means performing a search on all medical providers you employ or work with every month. Searching can also be cumbersome as it requires looking up different variations of each individual’s name in case they are using a nickname or middle name.
How MedTrainer Helps
If you’re running a hospital with thousands of medical professionals, keeping up with this can be a full-time job. Not to mention the risk of someone slipping through the cracks. The OIG, as we learned, takes its job very seriously and they do impose fines on healthcare providers who fail the exclusion screening process.
Thankfully, it doesn’t all have to fall on your shoulders. There are software companies that specialize in exclusions checks and can help you save time and avoid fines.
Medtrainer provides automated monthly exclusions checks from over 40 different sources including OIG so you don’t have to worry about missing a month. There is also automated reporting sent directly to your email and notifications when a task hasn’t been completed by specific employees.
If you’re looking to stay on the OIG’s good side, but also not spend all your time searching for fugitives, Medtrainer’s got you covered.
Schedule a demo today and see how quick and simple exclusion checks can be.