Have you heard of the Health & Human Services Office of Inspector General? The OIG, under a Congressional mandate, established a program to exclude individuals and entities affected by these various legal authorities, contained in sections 1128 and 1156 of the Social Security Act, and maintains a list of all currently excluded parties called the List of Excluded Individuals/Entities.
Bases for exclusion include convictions for program-related fraud (medicaid or medicare fraud) and patient abuse, licensing board actions (nursing board revokes or suspends a nursing license, etc.) and default on Health Education Assistance Loans. For additional information see the OIG website.
Why I am mentioning this today? I just had lunch with a nurse who was convicted several years ago of theft of drugs, a felony. His license was suspended by a Board of Nursing for a period of time. Now this nurse is being subjected to a mandatory five year exclusion from working in any healthcare facility in any capacity that receives federal funds (Medicaid, Medicare, and other federal healthcare programs). The most significant Federal health care programs are Medicare, Medicaid, Tricare and the Veterans programs.The exclusion is broad and comprehensive.
For example, as mentioned in an OIG Special Advisory Bulletin the following services may subject a facility or contractor to liability: Services performed by excluded nurses, technicians or other excluded individuals who work for a hospital, nursing home, home health agency or physician practice, where such services are related to administrative duties, preparation of surgical trays or review of treatment plans if such services are reimbursed directly or indirectly (such as through a PPS or a bundled payment) by a Federal health care program, even if the individuals do not furnish direct care to Federal program beneficiaries. See this link.
Felonious conduct for nurses in the context of providing care or related to the provision of healthcare may have many consequences: criminal, employment, administrative (board of nursing), civil, and/or professional (if credentialed and/or certified in a nursing specialty).
Nurses if you have been indicted for a felony or misdemeanor, retain a competent criminal defense attorney for the criminal matter AND a competent administrative attorney with experience in healthcare and nursing issues to represent, counsel, and advise you on the licensure issues. Proceeding pro se (without an attorney) has benefits (no cost to you) and risks (you may not know what to expect).
Don't have a rainy day legal fund? See my post on the benefit of purchasing an individual professional liability insurance policy with a licensure defense protection benefit. Also consider purchasing Legal Basics for Professional Nursing Practice; the legal monograph discusses OIG exclusions under the section on nurses as criminal defendants. See the Center for American Nurses website at www.centerforamericannurses.org to purchase. It costs $15.26 for ANA members and $16.95 for non-members.
I am a RN who is on the exclusion list. I recently applied for a position with the SSA/Disability office for the state of Ohio. Is this considered a "federal health care agency"? I don't want to waste my time going to Columbus for testing and an interview if I am only going to be turned down when they do a federal background check.
Posted by: Jennifer | May 21, 2016 at 06:31 PM