Two recent Department of Health and Human Services, Departmental Appeals Board decisions highlight the importance of regular federal and state background screenings and Medicare exclusion checks. The Ambulife Ambulance, Inc. decision emphasizes that reliance on past owners’ disclosures does not negate a provider/supplier’s duty to accurately report any past offenses and managing employees status. The Esohe Agbonkpolordecision reiterates that entering into a plea deal may be considered a conviction and, thus, appropriate grounds for exclusion from the Medicare, Medicaid, and all federal health care programs.
In Ambulife Ambulance, Inc., the Board upheld the decision to revoke an ambulance services supplier’s Medicare enrollment and billing privileges for providing false or misleading information in its Medicare enrollment applications.1 The supplier identified an individual as a managing employee in the role of chief operating officer on its Medicare enrollment application, but failed to disclose any adverse legal actions, including exclusions from a federal health care program. Two years later, the supplier submitted another Medicare enrollment application, following the acquisition by a new owner, which again affirmed that no owners or managers had been the subject of a final adverse legal action. In 2016, the supplier terminated the chief operating officer’s employment. In 2018, the Medicare Administrative Contractor informed the supplier that the Inspector General of the United States Department of Health and Human Services (“IG”) had revoked the supplier’s Medicare enrollment and it would be barred from re-enrollment for three years for providing false or misleading information on its enrollment applications because the individual identified as the chief operating officer had been included on the IG’s exclusions list, effective August 20, 2000. FULL ARTICLE