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By Deborah J. Juneau

To participate in the Louisiana Medicaid Program, providers have been required to ensure that their current and potential employees, contractors and other agents and affiliates were not excluded from participation in the Medicare or Medicaid Programs. Providers have been instructed to check the Department of Health and Human Services’ Office of Inspector General’s website for the list of excluded individuals and entities upon hire and monthly thereafter. These requirements have been included in the Provider Enrollment Agreements, the Medical Assistance Program Integrity Law, Louisiana Revised Statutes 46:437 et seq., referenced in the Louisiana Administrative Code Title 50, and the Code of Federal Regulations, 42 CFR §455.436.

The Louisiana Department of Health and Hospitals (“DHH”) has now implemented its own website to check for adverse actions taken against individuals and entities. The website is found at https://adverseactions.dhh.la.gov. Pursuant to guidance issued by DHH in September, 2014, effective immediately, providers are now directed to check the DHH website for all individuals and entities upon hire or contracting and monthly thereafter to determine whether they have had any adverse action imposed. Providers are required to maintain proof in their records that the checks were performed for employees and/or contractors, including subcontractors, by printing out the search results.

DHH directs that the search should include all current and previous names used (first, middle, last, maiden, married, and/or hyphenated names and aliases) for all owners, employees and contractors.

If the search conducted for potential employees or contractors reveals that the person or entity has been excluded from working with Medicare and/or the Louisiana Medicaid Program in any capacity, the provider should not employ or contract with the person or entity.

If the search reveals that an existing employee or contractor has been excluded from the Medicare and/or Louisiana Medicaid Programs, the provider must notify the DHH within ten (10) working days of discovering the exclusion and provide the following information: 1) the name of the excluded individual or entity; 2) the status of the individual or entity, whether an employee or contractor; 3) the beginning and ending dates of employment or contract; 4) documentation of the termination of employment or contract; and 5) the type of services provided to the provider by the excluded individual or entity. The findings should be reported to DHH.Medicaid.State.Exclusion@la.gov or to Department of Health and Hospitals, Program Integrity, P.O. Box 91030, Baton Rouge, LA 70821-9030. Providers who employ or contract with excluded individuals and entities may be subject to penalties, including monetary penalties.

DHH also made clear that using the new adverse actions web search tool does not replace the Nurse Aide Registry/Direct Service Worker Registry requirements. Providers that employ Certified Nursing Assistants (CNAs) and Direct Service Workers (DSWs) are still required to check those registries upon hire and every six (6) months thereafter.