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 individuals and 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 screening of excluded individuals and entities 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 is 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 Screening of Excluded Individuals and Entities Be Conducted?
In 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 of excluded individuals and entities. 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.
Monthly screening is recommended 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 does not always happen. It is 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 companies money.Use this step-by-step guide to learn about different OIG exclusions, how to conduct exclusion screening and achieve healthcare compliance.
How to Conduct the Screening Process
Knowing when to screen is not enough. It is also important to know how to effectively screen employees, contractors, and subcontractors and make sure that providers not overlooking any potential exclusions. The OIG has provided guidelines for the screening of excluded individuals and entities, which includes the following steps:
- First and foremost, companies need to determine which sources to screen. With the help of legal counsel, companies can ensure that sources and standards for screenings cover or go beyond both federal and state-level recommendations. Also, providers should make sure to have access to the latest database of screened names, familiarize with these sources and take note of which can be downloaded and which cannot. Some of these databases take the form of spreadsheets, Word documents, or PDF files, so it is necessary 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. Employees should be first in the list, of course. This step also entails reviewing if the services or items provided by a 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. Providers can do the screening of excluded individuals and entities themselves, or they can depend on the contractor to take care of their own employees. However, it is strongly advised that companies validate the results once the contractors are done with the task.
- During screening of excluded individuals and entities, providers 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 in case of matching names or details. For these, providers need to rely on identifiers, such as name variations, address, birthdate, and other pertinent data. Should these be unavailable, providers can always reach out to the data source. However, it is entirely possible that they won’t be able to give a prompt response.
- Finally, providers need to document the process. In the event of an audit, they will need to prove that they have 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 Screening of Excluded Individuals and Entities 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, providers can hand this task over to agencies that specialize in background checking. However, this can prove to be an expensive and time-consuming choice.
Exclusion screening software, however, can be programmed to comb through various forms of exclusion lists with every new update or whenever companies are 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. As a result, employers can not only be able to conduct exclusion screenings more promptly and regularly, but also reduce companies’ risk of incurring significant monetary losses.
Editor’s Note: This post has been updated for accuracy and comprehensiveness.