When a compliance officer finds an excluded provider has treated patients, what is the NEXT action they should take?

The most appropriate next action when a compliance officer discovers that an excluded provider has treated patients is to have the medical office check other exclusion lists. This step is critical because it ensures a comprehensive review of the provider’s status. Different exclusion lists may contain names that are not solely reflected in the primary exclusion list, such as those maintained by the Office of Inspector General (OIG) or other relevant entities.

By verifying the provider's status against multiple exclusion lists, the compliance officer can confirm whether the provider is indeed failing to meet eligibility criteria and ensure that proper protocols are followed for compliance. It is essential to act promptly in addressing compliance issues, especially those involving excluded providers, to mitigate risks and protect the organization from potential legal and financial repercussions associated with improper billing or care rendered by ineligible practitioners.

Other options, while potentially important in specific contexts, do not address the immediate need for thorough verification of the provider's status against various relevant lists. This verification lays the groundwork for any subsequent actions that may need to be taken, such as stopping the provider from providing care or consulting with legal counsel about the broader implications of the situation.