Healthcare Sanction Checking

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.

In November 2013, the Office of Inspector General (OIG) revealed its Strategic Plan for Fiscal Years 2014-2018.  Earlier this year, the OIG issued a Special Advisory Bulletin (SAB) concerning exclusion screening and more recently issued a report recommending mandatory background screening of child care providers. But what can you expect in 2014 and beyond?

On July 10, 2013, the Office of Inspector General (OIG) announced an upgrade to its Exclusions Search along with the July 2013 List of Excluded Individuals and Entities (LEIE) update. This isn’t the only recent change to this exclusion list. In June 2013, the OIG added new information to the list: the National Provider Identifier, a Waiver, and a Waiver State. With last month’s changes, the OIG released a redesigned exclusions search of the LEIE as well as the upgraded Online Exclusions Database and the LEIE Downloadable Databases. But what do these changes mean for you as an employer?

In May 2013, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a Special Advisory Bulletin concerning excluded individuals and entities. Within the advisory bulletin, the first in over a decade, the OIG alerted organizations receiving federal funding from Medicare that it is highly recommended that they monitor the OIG’s List of Excluded Individuals and Entities (LEIE) on a monthly basis in order to minimize their liability from civil monetary penalties.

On September 30, 1999 the U.S. Department of Health and Human Services’ Department of Inspector General released a Special Advisory Bulletin on The Effect of Exclusion from Participation in Federal Health Care Programs. The brief document set off a deluge of questions and requests for clarification on critical policy guidelines in the fourteen years following its release.

The US Department of Health and Human Services (DHHS), Office of Inspector General (OIG) released a "Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs" on May 8, 2013—the first in over ten years. The OIG originally published a Special Advisory Bulletin in September 1999. What does this mean for your organization's sanction screening practices? The updated 2013 bulletin expands the OIG's exclusion authority.

For many years, PreCheck and the National Healthcare Data Bank (NHDB) have utilized the General Services Administration (GSA) Excluded Parties List System (EPLS) on a daily basis to determine whether an individual or entity is excluded. The EPLS is a federal database containing the names of those individuals and entities that have been barred and excluded from doing business with the federal government.

In the world of healthcare the terms Sanctions and Board Actions are commonly used but often misunderstood. Sanctions and exclusions are actions taken by state and federal agencies with sanctioning authority against an individual or entity. Usually, the individual is a licensed healthcare professional. A Board Action, however, is an adverse action taken by a state licensing board against a healthcare professional's license.

Implementation of a strong sanction and exclusion screening program is just one of the various tools you rely on to ensure patient safety and program compliance. Further, conducting sanction screening protects your organization from civil monetary penalties. The requirement to check the names of employees, medical providers, and suppliers against the federal OIG and GSA exclusion lists seems pretty straightforward. Yet, you know that just checking the OIG Exclusions List is not enough.