It’s Your Call – January 2024

HIPAA: What happens if we employ an individual who is found to be on an exclusion list?

If you employ an individual who has been sanctioned or excluded by the Office of Inspector General (OIG) from participating in federal health care programs, and that individual provides reimbursable items or services under such programs, you may face Civil Monetary Penalty (CMP) liability. This liability could amount to fines of up to $10,000 for each item or service provided by the excluded individual, listed on a claim submitted for reimbursement under a Federal/State program. Additionally, there might be an assessment of up to three times the claimed amount, alongside program exclusion.

For liability to be established, the law stipulates that the provider submitting claims for health care items or services rendered by an excluded individual must either have actual knowledge or should have known about the exclusion status of the person involved. This requirement is outlined in section 1128A(a)(6) of the Act; 42 CFR 1003.102(a)(2). Providers and contracting entities are required to proactively verify the exclusion status of individuals or entities before engaging in employment or contractual arrangements. Failure to do so can result in CMP liability.

OSHA: What are the ANSI standards and its significance to OSHA requirements?

The American National Standards Institute (ANSI) is a non-profit organization that identifies and develops standards for products, technology, and services with collaboration from government and industry stakeholders. It represents the interests of more than 270,000 companies and organizations and 30 million professionals worldwide.

OSHA has adopted a number of ANSI and other industry consensus standards. Industry consensus standards can be evidence of recognized hazards that may need correction.  Under OSHA’s General Duty Clause, employers are required to “furnish to each of [its] employees’ employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to [its] employees.”

When new standards are available, OSHA may not adopt them instantly. For example, the latest ANSI standard for eyewash can be found at https://blog.ansi.org/2018/07/emergency-eyewash-station-shower-ansi-z358-1/#gref . Employers will not be cited for complying with the current ANSI standard as long as the new one is equally protective. At a minimum, employers should comply with the standards that OSHA has adopted.