Got Any Skeletons in Your Closet?

05/02/11 - Life at NYULMC

Remember that “background check” you went through before being hired here? Did you know that, in compliance with state law, NYULMC conducts another type of background check on you every single month? 

Several important federal and state agencies, such as the US Department of Health and Human Services and the New York State Office of the Medicaid Inspector General (OMIG), have developed “exclusion lists,” which identify businesses and individuals who are prohibited from participating in federal and state healthcare programs because they have broken the law. 

Reasons for exclusion include:

• convictions for program-related fraud
• patient abuse
• sexual assault
• substance abuse
• licensing-board actions
• default on student loans. 

In response to new requirements of the New York OMIG, the Internal Audit Department of the NYULMC Office of Compliance, Privacy and Internal Audit performs automated, monthly comparisons of the names of all faculty, staff, referring physicians, vendors, and anyone associated with the Medical Center with the various federal and state exclusions lists. 

What happens if there is a match? 

The Internal Audit Department evaluates the accuracy of any preliminary match. If a match is confirmed, the Medical Center must make a formal disclosure to the agency that issued the exclusion list about the nature and duration of the relationship between the Medical Center and the excluded individual or vendor. 

Civil monetary penalties of $10,000 per claim, damages and False Claims Act liability can be imposed on the Medical Center for billing for services rendered by an excluded individual (such as an attending physician or nurse) or entering into a contract with an excluded vendor. The Medical Center cannot receive payment for goods and services provided by excluded individuals nor can the Medical Center include services provided by excluded vendors on its cost reports. Therefore, individuals who are confirmed as excluded may be subject to disciplinary action, up to and including termination. Vendors who are confirmed as excluded will have their contracts reviewed immediately. 

If you have questions about the monthly exclusions checks, please contact Pierre Dubose, director of internal audit, at 212-404-3609.