Written by: Connie Dreyer, MHCA Nurse Consultant  

It has come to the attention of Minnesota HomeCare Association (MHCA) that some providers may not be aware that there are both federal and state requirements related to checking for employees who may be on an exclusion list!  

Federal Office of Inspector General (OIG)  is required by law to exclude from participation in all federal health care programs individuals and entities convicted of certain criminal offenses, including Medicare or Medicaid fraud as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP or other state health care programs. Click here to review the OIG Exclusions website for more information. 

State Inspector General (DHS) also has an “Excluded Provider List” that contains information on individuals and entities whose participation in the Minnesota Health Care Programs (MHCP) has been suspended or terminated for cause.  An individual or entity on the exclusion list may not submit a claim for payment by MHCP, individually or through a claim submitted by a clinic, group, corporation, or professional association, unless services were provided before the effective date of the suspension or termination  Enrolled MHCP Providers have an obligation to check the DHS exclusion list to ensure that they are not employing an individual, or submitting claims for services provided by an individual, on the list. 

Since people are placed on the federal OIG exclusion list by the federal government, it is possible that an individual would be on both lists.  However, there are people on the state list who are not on the federal list and vice versa.   For both programs, no payments will be made, directly or indirectly, for services provided by an individual on either of the excluded provider list.  

MHCA encourages Minnesota home care providers who bill Medicare and/or Medical Assistance, check both exclusion lists for their current/potential employees.