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What is a CMP and how does it apply to the LEIE?

In our Cover Your Attestation article series, we discussed how FDRs (first-tier, downstream, and related entities) must check the List of Excluded Individuals and Entities (LEIE) before credentialing, hiring, or contracting with any individual or entity for items or services payable by Federal healthcare programs and on a regular basis thereafter.

As we stress the importance of screening all employees/vendors/subcontractors against the LEIE list prior to hiring or contracting and then re-checking monthly thereafter; a few questions have been asked:

  • What is a CMP?
  • How does a CMP apply to the LEIE?

What is a Civil Monetary Penalty (CMP)?

Under the Social Security Act, the Secretary of HHS is authorized to seek civil monetary penalties (CMPs), assessments, and exclusion for many types of conduct. Many of these responsibilities have been delegated to the Office of Inspector General (OIG). Under the Civil Monetary Penalties Law (CMPL), penalties of up to $50,000 per violation are authorized, and assessments of up to three times the amount claimed for each item or service, or up to three times the amount of remuneration offered, paid, solicited, or received.

According to CMS, violations that may give rise to CMPs include:

  • Presenting a claim that you know or should know is for an item or service not provided as claimed or that is false and fraudulent;
  • Presenting a claim that you know or should know is for an item or service for which Medicare will not pay; and
  • Violating the Anti-Kickback Statute.

How does a CMP apply to the LEIE?

According to the OIG, “providers have an affirmative duty to check the program exclusion status of individuals and entities before entering into employment or contractual relationships, or run the risk of CMP liability if they fail to do so.” This means anyone who hires an individual or entity on the LEIE may be subject to CMP.  The OIG emphasizes the importance of checking the LEIE to avoid CMP liability by stating “health care entities need to routinely check the LEIE to ensure that new hires and current employees are not on the excluded list.”  In a letter to all state Medicaid directors CMS stated that “providers should search the LEIE monthly” and “immediately report to states any exclusion information discovered.”

How we can help

Now that we have launched our affordable OIG Exclusion List Service, we can help your organization avoid a CMP by ensuring all employees, vendors, and subcontractors are being screened against the LEIE prior to hiring or contracting and monthly thereafter.  While there may only be a small chance you will deal with any excluded individual or entity, checking the LEIE on a monthly basis is one of the best ways your organization can avoid a CMP.

If you have any questions about CMPs, LEIE questions, or if you would like to hear more about our OIG Exclusion List Service or any of our other Corporate Plus program services, please comment below, send us an email [email protected] or reach us by phone toll-free 855-427-0427.

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