Reporting of Board Discipline Mark Johnston, RPh Executive Director Idaho State Board of Pharmacy
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)
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.
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
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.
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.
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
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
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
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
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.
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
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.
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
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!
Contact Information DHHS/OIG/OI- Exclusion Staff Boston Regional Office, JFK Federal Building, Room 2475, Boston, MA 02203 Phone: 617-565-2664 Maine, Mass, New Hampshire, Connecticut, Vermont, Rhode Island New York Regional Office, 26 Federal Plaza, Room 13-124, New York, NY 10278 Phone: 212-264-1691 New York, New Jersey, Puerto Rico Philadelphia Regional Office, 150 South Independence Mall West, Suite 329, Philadelphia, PA 19106 Phone: 215-861-4586 DC, Pennsylvania, Delaware, Maryland, West Virginia, Virginia Atlanta Regional Office, 61 Forsyth Street, Suite 5T18, Atlanta, GA 30303 Phone: 404-562-7603 Kentucky, Tennessee, North Carolina, South Carolina, Georgia, Alabama, and Mississippi Miami Regional Office, 7175 Security Boulevard, Ste 210, Baltimore, MD 21244 Telephone: 410-281-3060 Florida
Chicago Regional Office, 233 N Michigan Ave, Suite 1330, Chicago, IL 60601 Phone: 312-353-2740 Ohio, Michigan, Indiana, Illinois (Northern District), Wisconsin, Minnesota Kansas City Regional Office, 7175 Security Boulevard, Ste 210, Baltimore, MD 21244 Phone: 410-281-3060 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 75242 Phone: 214-767-8406 Arkansas, Louisiana, Texas, Oklahoma, New Mexico Los Angeles Regional Office, 600 West Santa Ana Blvd, Ste 1100, Santa Ana, CA 92701 Phone: 714-246-8302 Arizona, Nevada, Hawaii, California (Southern District) San Francisco Regional Office, 1855 Gateway Blvd, Suite 585, Concord, CA 94520 Phone: 925-356-7558 Washington, Idaho, Oregon, California (Northern, Eastern, Central Districts), Alaska