Reporting of Board Discipline. Mark Johnston, RPh Executive Director Idaho State Board of Pharmacy

Transcription

1 Reporting of Board Discipline Mark Johnston, RPh Executive Director Idaho State Board of Pharmacy

2 HIPDB The Healthcare Integrity and Protection Data Bank Part of the Health Care Fraud and Abuse Control Program, created by HIPAA Operated by Health and Human Services (HHS)

3 HIPDB A national, central database of adverse action information taken against health care practitioners, providers and suppliers. Available for use, for a charge, by employers, professional societies, state and federal government agencies, self query, research, and plaintiff s attorneys.

4 HIPDB Who is legally required to report? Health Plans Federal & State prosecutors FBI State licensing boards Medicaid fraud control units VA, US DOJ, DEA, CMS, OIG and HHS

5 HIPDB A database that BOPs must submit administrative discipline to that exists to create a permanent record of criminal and fraudulent behavior to be used by prospective employers, by malpractice attorneys, and for criminal, civil and administrative action, such as evaluating the background of an expert witness or during sentencing.

6 OIG s LEIE Office of Inspector General, U.S. Department of Health & Human Services List of Excluded Individuals & Entities. Excluded from What participation in Medicare, Medicaid, and more than 300 other HHS programs An entity should query the LEIE prior to hiring and usually will not employ or contract with any individual or entity that has been excluded from any government funded program.

7 OIG s LEIE Mandatory Exclusions: Conviction of Program Related Crimes Convictions relating to Patients Abuse Felony Conviction Relating to Health Care Fraud Felony Conviction Relating to Controlled Substance

8 OIG s LEIE Permissive Exclusions (OIG staff evaluates) Conviction relating to fraud. Conviction relating to obstruction of an investigation or audit. Misdemeanor conviction relating to controlled substance. License revocation or suspension. Exclusion or suspension under federal or state health care program. Failure to disclose required information

9 OIG s LEIE Claims for excessive charges or unnecessary services and failure of certain organizations to furnish medically necessary services Fraud, kickbacks, and other prohibited activities. Entities controlled by a sanctioned individual. Individuals Controlling a Sanctioned Entity Making false statements or misrepresentations of material facts

10 OIG s LEIE Failure to disclose required information Failure to supply requested information on subcontractors and suppliers Failure to supply payment information Failure to grant immediate access Failure to take corrective action Default on health education loan or scholarship obligations

11 OIG s LEIE Although OIG is required to submit data to the HIPDB, OIG does not use HIPDB data. The program is voluntary, but highly recommended by OIG. OIG will only process an exclusion for a suspension of one year or greater. The time of exclusion is only the time of the suspension plus the time it takes the excluded individual to complete the reinstatement process.

12 OIG s LEIE Documents needed for an HHS Exclusion under a conviction: Final judgment order Charging documents Plea agreements Summary of the case Point of contact

13 EPLS Excluded Parties List System: A list of individuals and firms excluded by Federal government agencies from receiving federal contracts or federally approved subcontracts and from certain types of federal financial and nonfinancial assistance and benefits.

14 EPLS Requires federal contracting officers to review the EPLS after the opening of bids or receipt of proposals Only federal agencies may submit data Thus, not a Board of Pharmacy concern

15 Conclusion NABP reports to HIPDB for BOPs for no additional charge. Not reporting is illegal. As the OIG LEIE is voluntary, with each decision that may result in a permissive exclusion, including suspensions of one year or more, your Board should decide whether to submit or not. EPLS is not pertinent to BOPs. Don t fear that suspensions of less than one year carry greater repercussions!

16 Contact Information DHHS/OIG/OI- Exclusion Staff Boston Regional Office, JFK Federal Building, Room 2475, Boston, MA Phone: Maine, Mass, New Hampshire, Connecticut, Vermont, Rhode Island New York Regional Office, 26 Federal Plaza, Room , New York, NY Phone: New York, New Jersey, Puerto Rico Philadelphia Regional Office, 150 South Independence Mall West, Suite 329, Philadelphia, PA Phone: DC, Pennsylvania, Delaware, Maryland, West Virginia, Virginia Atlanta Regional Office, 61 Forsyth Street, Suite 5T18, Atlanta, GA Phone: Kentucky, Tennessee, North Carolina, South Carolina, Georgia, Alabama, and Mississippi Miami Regional Office, 7175 Security Boulevard, Ste 210, Baltimore, MD Telephone: Florida

17 Chicago Regional Office, 233 N Michigan Ave, Suite 1330, Chicago, IL Phone: Ohio, Michigan, Indiana, Illinois (Northern District), Wisconsin, Minnesota Kansas City Regional Office, 7175 Security Boulevard, Ste 210, Baltimore, MD Phone: Iowa, Illinois (Southern, Central Districts), Missouri, Kansas, Nebraska, North Dakota, South Dakota, Montana, Wyoming, Utah, Colorado Dallas Regional Office, 1100 Commerce St, Room 629, Dallas, TX Phone: Arkansas, Louisiana, Texas, Oklahoma, New Mexico Los Angeles Regional Office, 600 West Santa Ana Blvd, Ste 1100, Santa Ana, CA Phone: Arizona, Nevada, Hawaii, California (Southern District) San Francisco Regional Office, 1855 Gateway Blvd, Suite 585, Concord, CA Phone: Washington, Idaho, Oregon, California (Northern, Eastern, Central Districts), Alaska