Exclusion Screening

It’s that time of the year again and I don’t necessarily mean it due to the upcoming holiday season. On October 31^st, the U.S. Department of Health and Human Services released its Work Plan for the fiscal year 2015, which summarizes new and ongoing reviews and activities the Office of Inspector General (OIG) will pursue in the coming year and beyond. As a healthcare background screening firm, I thought I would highlight four key areas from the 2015 Work Plan that contain background check-related implications for healthcare organizations.

We recently discussed how often hospitals should run background checks on employees, but what about healthcare organizations in general? Even for non-hospital care organizations, patient care is still a concern. In fact, in its most recent work plan, the Office of Inspector General (OIG) stated it would continue to focus on the safety of long-term healthcare facilities in 2014 and beyond.

Background checks are a fundamental practice for hospitals to ensure safety amongst patients and staff alike. A highly regulated industry like healthcare is urged to apply more stringent policies due to the fact that lives are at risk every day and patient-sensitive information can be easily accessed.

The topic of background checks on home healthcare workers has received significant attention from the media recently. By now, you’ve probably heard the stories of home healthcare workers who’ve taken advantage of vulnerable elderly patients. In the 2014 OIG Work Plan released in February, the agency declared it would focus on the adverse events occurring in home health facilities across the country.

In March, the OIG published a report titled, “CMS’s Process for Sharing Information About Terminated Providers Needs Improvement.” As the title suggests, DHHS has determined that CMS does not properly share information regarding terminated providers with other states. As we’ve discussed before, section 6501 of the Patient Protection and Affordable Care Act (ACA) requires State Medicaid programs to terminate participation of providers if terminated under Medicare, another State Medicaid program, or CHIP.

Earlier this year, we addressed some of the frequently asked questions concerning exclusion and sanction screening. This article focuses on the current recommended best practices for the healthcare industry, given the latest publicly available exclusion information, as well as recommendations and guidelines from regulatory agencies.

While PreCheck is a longtime supporter and exhibitor of the Health Care Compliance Association (HCCA) Compliance Institute, this was my first time attending the conference as an attendee. As a healthcare exclusive background screening firm, it is imperative that we as an organization stay abreast of the latest healthcare regulations that affect our clients in this complex industry. I think we can all agree that healthcare is ever-changing.

As PreCheck’s Principal Consultant for Sanction Screening, I work with healthcare compliance officers every day to protect their facilities from excluded individuals and entities. With over ten years conducting sanction checks, I’ve seen dozens of scenarios and have helped clients identify physicians, employees and vendors who have been excluded from participating in federal health programs.

The Department of Health and Human Services Office of Inspector General recently released the 2014 OIG Work Plan, which addresses the various projects it will focus on during this fiscal year.

2013 was a very special year for PreCheck. We celebrated our 20th anniversary exclusively serving the healthcare industry and our Blog also had its first birthday last summer. As we look forward to another great year of new milestones, here’s a look back at ten of our most popular blog articles from last year.