US Attorney Erin Creegan announced on December 10 that the US Attorney’s Office for the District of New Hampshire has entered into a settlement agreement with a New Hampshire-based telehealth mental-health provider and its owner. Under the agreement, they will pay $300,000 to resolve allegations that they violated the False Claims Act by improperly billing Medicaid for services provided by an individual who had been excluded from federal healthcare programs.
Federal law prohibits Medicaid and other federal healthcare programs from paying for services furnished by individuals excluded by the US Department of Health and Human Services Office of Inspector General (HHS-OIG). HHS-OIG advises providers to regularly check the List of Excluded Individuals/Entities (LEIE) to avoid potential liability.
According to the United States, the company and its owner submitted claims for services performed by an excluded individual, resulting in reimbursements that were not eligible for payment. To resolve their potential liability, the company and its owner agreed to pay $300,000, an amount based on their ability to pay.
The US Attorney’s Office, along with the Department of Justice’s Criminal Division, Fraud Section, also handled the criminal prosecution of the excluded individual, who pleaded guilty to one count of healthcare fraud on October 23, 2025. The company and its owner fully cooperated in the parallel criminal investigation.
US Attorney Creegan said, “A provider is federally excluded from being paid to give healthcare for good reasons, such as prior fraud, criminal convictions, or patient abuse. To protect the public, we will hold accountable those who violate healthcare exclusions.”
Compliance Perspective
Issue
Healthcare organizations that receive federal or state reimbursement must ensure that no excluded individuals or entities provide services for which payment will be sought. The HHS-OIG maintains the LEIE, and federal healthcare programs will not pay for any items or services furnished, directed, or prescribed by an excluded person. Failure to consistently screen employees, contractors, and vendors can result in significant financial liability, compliance risks, and potential enforcement actions. Routine monitoring and documented internal controls are essential to prevent accidental billing for services connected to an excluded individual.
Discussion Points
- Review policies and procedures that address screening of prospective and current employees, contractors, and service providers against the OIG LEIE. Policies should specify the timing of initial checks, the frequency of ongoing reviews, documentation requirements, and follow-up steps when potential matches are identified. Facilities may also consider collaborating with an external compliance consultant who can assist in evaluating existing processes, performing focused reviews, or helping to strengthen policies to align with current regulatory expectations.
- Ensure that staff involved in hiring, credentialing, compliance, and billing receive ongoing training on exclusion requirements, including how to access and use the OIG Exclusion List, the risks of employing an excluded individual, and proper documentation practices. Med-Net Academy offers courses that support these efforts, including Office of Inspector General (OIG) Exclusion List, which reviews examples of excluded individuals, the consequences of hiring an excluded person, and how to verify exclusion status, and Staying on Top of Employee Checks, which covers the OIG Exclusion List, the List of Debarred Contractors, licensing and certification verifications, and background screening procedures.
- Conduct periodic audits to confirm that exclusion checks are being performed consistently and documented appropriately for all new hires and current personnel, including contractors or telehealth providers. Audits should also verify that no claims have been submitted for services connected to excluded individuals. Organizations may benefit from engaging an independent reviewer or consultant to conduct mock audits, identify gaps in the screening process, and help develop corrective action plans that strengthen compliance and mitigate future risk.
*This news alert has been prepared by Med-Net Concepts, Inc. for info