Exclusion Screening

How Often Should Employers Screen Excluded Individuals?



Jeff Aleixo

Screening for individuals and entities that have been excluded from participating in healthcare programs is a must for any healthcare provider. After all, contracting or employing the services of excluded entities can result in significant monetary penalties, Medicaid payment bans, and the possibility of earning exclusion for the company itself.

Given this situation, it seems like the most favorable approach for healthcare providers would be to conduct sanction screenings as often as possible. This is a fairly easy task for a smaller company, but not for one that has hundreds or thousands of employees. Going through a large number of individuals every month will require a dedicated group of people and can eat up a considerable amount of time and resources.

It’s important to strike a perfect balance between complying with rules and reducing the cost of compliance. To do this, perfect timing is key.

How Often Should Sanction Screenings be Conducted?

In a May 8, 2013 Special Advisory Bulletin (SAB), the United States Department of Health and Human Services Office of Inspector General (OIG) said that providers are under no obligation, by statute or regulation, to check the List of Excluded Individuals and Entities (LEIE). As such, they are free to set the frequency or instances wherein they have to check their employees, contractors, or new hires to ensure that they have not been excluded from participation in federal health programs.

However, in the same bulletin, the OIG recommended that health providers carry out a monthly screening. This frequency is supported by a January 16, 2009 letter sent by the Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) to State Medicaid Directors. It has also been mentioned in the February 2011 Rules and Regulations set by the CMS.

Why monthly? This is because the OIG updates the LEIE on a monthly basis. As such, the most opportune time to do a screening would be right after the exclusion list is updated every month. This schedule offers the best chance of minimizing overpayment and liability with the CMS. At the same time, it also does away with the added cost and effort of conducting screenings at random.

Take note, though, that the LEIE is managed by the OIG at the federal level. Aside from this list, there are other federal- and state-level exclusion lists that are managed and maintained by different states. In theory, the names appearing in the LEIE should also appear in the state level list and vice versa, but this doesn’t always happen. It’s entirely possible that individuals and entities not present in the federal list are present in the state list, and not screening one list or the other can cost your company money.

The Screening Process — How it’s Done

Knowing when to screen isn’t enough. It’s also important to know how to effectively screen your employees, contractors, and subcontractors and make sure that you’re not overlooking any potential exclusions. The OIG has provided guidelines for the screening process, which includes the following steps:

First and foremost, you need to determine which sources to screen. You’ll need the help of your legal counsel to ensure that your sources and standards for screenings cover or go beyond both federal- and state-level recommendations. Also, make sure that you have access to the latest database of screened names. Familiarize yourself with these sources and take note of which can be downloaded and which can’t. Some of these databases take the form of spreadsheets, Word documents, or PDF files, so you have to produce a step-by step screening process for each. This can be a tricky job.

The next step is to find out who to screen. Your employees should be first in the list, of course. This step also entails reviewing if the services or items provided by your company’s contractor, subcontractor, or the employees of the contractors are payable, in part or in full, by a federal health program. If so, then they should also be screened on a regular basis. You can do the screening yourself, or you can depend on the contractor to take care of their own employees. However, it’s strongly advised that you validate the results once the contractors are done with the task.

During screening, you should also be aware of what you’re looking for. For example, the LEIE includes information such as the name, state, and provider type that the person used at the time of the exclusion. The employer can then input the person’s Social Security Number (SSN) or Employer Identification Number (EIN) to verify the result. However, some databases might not offer means of verification, which can be a problem if you find matching names or details. For these, you need to rely on identifiers, such as name variations, address, birthdate, and other pertinent data. Should these be unavailable, you can always reach out to the data source. However, it’s entirely possible that they won’t be able to give you a prompt response.

Finally, don’t forget to document your process. In the event of an audit, you’ll need to prove that you’ve taken every necessary step to not hire an excluded person and to clear name matches. This step can be done by taking screenshots and time stamps.

Making Monthly Screenings Less Complicated

Manually screening for OIG and other exclusions every month is a labor-intensive job, especially for a large company. To lessen the effort required, you can hand this task over to agencies that specialize in background checking. However, this can prove to be an expensive and time-consuming choice.

Contact Emptech for a more cost and time-efficient approach–we specializes in exclusion screening technology with peer review. OIG technology detection software, for example, can be programmed to comb through various forms of exclusion lists with every new update or whenever you’re considering hiring a new employee.

Advances in screening technology will prove to be a game-changer in making the detection process cheaper, faster, and more reliable in the long run.

Emptech’s pioneering technology makes it easy to

  • Explore these options for screening
  • Thoroughly examine individuals
  • Find one that suits your company’s needs

Once you do, you’ll not only be able to conduct exclusion screenings more promptly and regularly, you’ll also reduce your company’s risk of incurring significant monetary losses.

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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