The Cost of Not Checking Exclusion Lists: Maine Ambulance Company Enters into False Claims Act Settlement

County Ambulance, Inc. (“County Ambulance”) of Ellsworth, Maine, recently agreed to settle a claim brought by the United States and the State of Maine for the submission of false claims to Medicare and MaineCare, under which it will pay $16,776.74. The complaint indicated that County Ambulance compensated an employee who had previously been excluded from Federal health care programs with Medicare and MaineCare funds. County Ambulance neglected to check the Office of Inspector General’s (“OIG”) List of Excluded Individuals/Entities, a database of all individuals and entities currently excluded from participation in all Federal health care programs, to determine the exclusion status of the employee.

Excluded individuals and entities present significant risks to health care providers that participate in Federal health care programs. If a health care provider employs, contracts, or otherwise associates with an excluded individual or entity and seeks reimbursement under a Federal health care program for the items or services provided by the excluded individual or entity, the provider may be subject to significant civil money penalties and even Federal health care program exclusion. As the Ellsworth settlement underscores, health care providers also may not use Federal health care program funds to cover the salaries and benefits of excluded individuals.

This most recent settlement demonstrates that the OIG does not hesitate to crack down on health care providers who engage with excluded individuals and entities, and should serve as a warning to Maine health care providers that the Federal government is paying attention. All health care providers are strongly encouraged to check the exclusion status all of individuals and entities at https://exclusions.oig.hhs.gov/ prior to engaging with them and recurrently throughout the year to ensure continued good standing, and may be held accountable if they fail to do so. Performing such due diligence is easy, while failure to do so can have costly consequences.  

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Please do not hesitate to contact Steve Johnson, Esq. (sjohnson@kozakgayer.com), Mike Burian, Esq. (mburian@kozakgayer.com), or Taylor Fawns, Esq. (tfawns@kozakgayer.com), at (207) 621-4390 if you have questions regarding OIG exclusion.