Healthcare Sanction Checking

Individuals who engage in fraud or abuse in the healthcare industry can put patients and taxpayers at risk of physical or financial harm. For this reason, the U.S. Office of the Inspector General (OIG) can exclude certain people or organizations from providing services under federally funded healthcare programs. 

In November 2019, the Centers for Medicare and Medicaid Services (CMS) issued a rule on “bad actors.” The term refers to providers or suppliers whose histories demonstrate conduct or relationships that pose risks to taxpayers, patients or program

As we kick off the New Year, here’s a look back at the most popular posts from the previous year. 2018 was a year with a heightened focus on compliance for employers as FCRA litigation ensues while the healthcare industry faces the ongoing challenges of a rapidly changing sector. Background check compliance, drug testing, workplace appreciation, and the Death Master File Search are all topics that were most popular among our readers in the past year.

For healthcare organizations facing a hyper-competitive market and an aging customer base that requires more care, contingent staffing, also known as supplemental staffing, can play an integral role in HR's strategic planning process as a means to acquire on-demand, qualified healthcare talent.

Although not a novel concept, the practice of continuous, constant background screening has recently gained momentum among employers.

The U.S. Department of Health and Human Services (HHS) Office of Inspector General’s (OIG) Work Plan is one of the most valuable resources available for healthcare compliance professionals. The OIG’s work planning process is dynamic and adjustments are made throughout the year to meet priorities and to anticipate and respond to emerging issues with the resources available. Previously, the OIG updated its public-facing Work Plan once or twice a year, but their update cadence has changed as of last month.

The healthcare industry is one of the most complex and highly regulated, which means employers have a greater responsibility to ensure a safe workplace environment not just for their own staff, but also for patients. The past decade has seen advancements in technology and best practices for the industry, with the Affordable Care Act (ACA) placing greater emphasis on quality of care and patient safety. Industry regulators have provided updated guidance and newer technologies have allowed leading organizations and systems to improve the efficiency of their screening efforts.

Last week, the 21st Health Care Compliance Association (HCCA) Compliance Institute was held in National Harbor, Maryland. Adjacent to our nation’s capital, Washington, D.C., National Harbor was the perfect location to hear from regulators such as the Office of Inspector General (OIG) and its various departments.

While most healthcare employers conduct some form of employment background checks to safeguard their patients and staff, these screenings should not be limited to the ones conducted at the time of hire. Indeed, background screening experts have identified the emergence of a new trend referred to as infinity screening. “Infinity screening is the process of conducting background checks on current employees on a periodic or ongoing basis to stay informed about life changes which could create increased risk for your organization,” W.

Healthcare exclusions can be costly for healthcare organizations. The Department of Health and Human Services (DHHS) Office of Inspector General (OIG) has authority to implement exclusions and exclude providers from participating in federal healthcare programs such as Medicare and Medicaid. If your healthcare organization engages excluded individuals or entities, you could be liable for civil monetary penalties (CMPs).

Here are five things healthcare organizations should know about healthcare exclusions: