Exclusion Screening

Best Practices for Exclusion Sanctions Screenings



Jeff Aleixo

Earning an exclusion from the Department of Health and Human Services Office of Inspector General (OIG) can spell the end of a career or business in the healthcare industry. Once excluded or sanctioned, an individual or entity is prohibited from receiving payment or reimbursement from any Federal healthcare program, which includes Medicare and Medicaid. The payment prohibition affects the person, anyone who contracts or employs the excluded person, and health providers that service the said person.

If a company is found to be using federal healthcare funds to service or pay an excluded individual, it can face hefty fines and civil monetary penalties. These include $10,000 for each claimed item or service furnished to the individual, up to 3 times the amount claimed for each item or service, and the possibility of also getting excluded. In order to avoid these, it is a must for companies, especially healthcare providers, to regularly and diligently screen their employees, contractors, and subcontractors for exclusions and sanctions.

Exclusion List Database

Before screening, you need to go through the exclusion lists managed and maintained by the entities that give out the sanctions, which is either the OIG or a state Medicaid agency. The OIG’s List of Excluded Individuals and Entities (LEIE) is the primary federal-level list that should be consulted when searching for currently excluded individuals. You should also check the General Services Administration’s (GSA) Excluded Parties List System (EPLS) if you want to see the list of companies and individuals that have been barred from receiving federal contracts. The LEIE is updated every month while the GSA-System for Award Management, which includes the EPLS, is typically updated every week.

Then, there are the state-level exclusion lists that are separately maintained by different states. Ideally, the names included in the state-level lists should also be found in the LEIE, but this isn’t always the case. As such, it’s best to also consult your state’s exclusion list whenever you’re screening a person. How often these lists are updated depends on the state.

Screening: Whose Responsibility Is It?

Any person who provides any service or item that is being paid in part or in full by any federal healthcare program must be screened. This may include your employees, contractors, subcontractors, and even the people employed by your contractors. Employees should be screened by the human resources department. Screening physicians falls on the hands of the credentialing committee. Prior to contracting, the procurement department should also conduct their own screening to ensure that their contractors and vendors are not in any of the sanction lists. Your contractor can screen their employees, but the result of the screening should always be validated by your company’s compliance officer.

The sheer number of names to be screened and the different formats, update schedules, and features of the sanction lists can make manual screenings a complicated and time-consuming task. Because of this, many companies employ the services of agencies that specialize in background searches. However, this can be a costly choice, especially for large companies with more than a hundred employees. Capitalizing on exclusion screening technologies is also an option for companies that want cost-effective and quick searches with reliable results. But if you are conducting manual screenings, it’s important to incorporate the following best practices to your screening process.

  1. Screening Frequency
    The OIG updates the LEIE list every month and recommends that providers screen their employees on a monthly basis. Adhering to this guideline lowers financial risk as it allows the company to detect sanctioned employees or contractors as early as possible and minimize the amount of potential take backs and fines from CMS. For larger companies where a monthly screening will prove to be too costly, a regular automated screening is highly recommended. In addition, screening employees, physicians, and contractors or vendors before getting them on board is also a must.
  2. Name Matching
    When doing manual searches, exact matches of first and last names will only get you so far. To ensure the reliability and accuracy of the search, you have to consider name variations, maiden names, hyphenations, international names, and even spelling errors. In fact, it’s not entirely impossible that some of the names in the sanction lists have been misspelled. This, however, is not an excuse for failing to detect an excluded individual. Some lists, like the LEIE, have a validation mechanism that uses the employee’s Social Security Number (SSN). But for lists that don’t offer this feature, you can try matching other available details, such as the individual’s birthdate, state, or employer name.
  3. Vendor Matching
    Compared to matching individuals, matching vendors can be a bit trickier. This is because aside from the vendor name and Employer Identification Number (EIN), there’s not a lot of information you can use for the searches. What you can do is limit the number of your search results by omitting common words, like healthcare and America, from the keywords. In order to minimize the financial risks, you can also choose to prioritize contractors that get paid beyond a certain amount.
  4. Documentation
    Documentation plays an important role in case you do find a match or a probable match, or in case of an audit. It’s a good idea to keep screenshots, documents, and time stamps of the names that have already been reviewed, the exclusion list the names were reviewed against, and the process of determining a match.

Complying with healthcare exclusion screening guidelines set by the OIG remains a challenge for many companies and healthcare providers. However, it’s a necessary step towards minimizing misconducts, avoiding costly fines, and remaining in good standing with the OIG. At times, your searches can be limited by the available information, the search features the can be used to filter the exclusion list, or the sheer number of resulting matches. When these happen, don’t be afraid to ask for help. You can approach the employee or contractor in question for an honest discussion or ask your company’s legal counsel for other options. Luckily, Emptech’s proprietary technology makes it easy to Just make sure that every single time you conduct a search, you are doing it with due diligence, utmost care, and all your attention. . Luckily, Emptech’s proprietary technology streamlines the screening process for your company making it easy to screen thousands of employees monthly, automatically.

To learn more about our advanced sanction screening processes and the advantages of using an algorithmic and per-reviewed approach, you can get in touch with us by calling 888.443.8046 or by sending us an email at info@emptech.com.

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