Compliance in the healthcare hiring space involves careful conformity to complex and ever-evolving legal, professional, and ethical standards. But compliance, though complicated, is critical; protecting patient safety and the organization’s financial and reputational integrity depend on it. One vital area of compliance is sanction and exclusion monitoring. Accurate’s comprehensive healthcare workforce screening solutions allow organizations to conduct pre-hire screens as well as manage and monitor their workforce continuously to ensure that excluded or sanctioned individuals are not part of the team and cannot interfere with the daily business of patient care.
To understand better the importance of healthcare sanctioned screenings, this article will examine the following:
- What are sanctions and exclusions?
- Where can sanction and exclusion information be found?
- Why is sanction screening important?
- How can Accurate help?
What are sanctions and exclusions?
A healthcare sanction is an administrative action taken against an individual, an individual’s professional license, or an entity. The consequences of sanctions vary, but the most serious result is an exclusion, which prohibits the sanctioned individual or entity from providing federally-funded healthcare services or participating in federal health care programs. Excluded providers cannot receive any payment from federal- or state-funded healthcare programs for any services they provide and anyone who hires an excluded individual or entity or continues to keep an excluded individual within the organization may be subject to civil monetary penalties.
Exclusions come in two forms:
Mandatory Exclusions –These exclusions are compulsory following the commitment of any applicable offense. Mandatory exclusions are effective for a minimum of five years but can be infinite in duration. Removal from a mandatory exclusion list is not automatic; individuals or entities must apply for reinstatement at the end of the exclusion term.
Applicable offenses include the following:
- Fraud involving Medicare, Medicaid, SCHIP, or any other state or federal healthcare program.
- Abuse or neglect of a patient.
- Felony convictions for financial crimes or theft
- Felony convictions for the illegal distribution, manufacture, sales, or prescribing of controlled substances.
Permissive Exclusions—These exclusions are discretionary and need not be healthcare-related. These exclusions are typically in effect for one to three years and an application must be made and approved for the exclusion to be lifted.
- Student loan defaults
- Illegal kickbacks
- Dishonest healthcare claims or information
- Misdemeanor convictions for medical fraud
- Misdemeanor convictions for controlled substance violations
Exclusions can ruin a healthcare provider’s career and severely compromise any organization found to be employing an excluded provider.
Your responsibility for healthcare sanctions screenings is twofold. First, all new hires must be thoroughly screened to prevent onboarding sanctioned or excluded individuals. Second, exclusion lists must be monitored on an ongoing basis to ensure no current employees are in violation of healthcare sanction regulations since it’s not unusual for problems to occur after an employee is hired.
Where can sanction and exclusion information be found?
A key component in compliance efforts is regularly checking and cross-checking all the alphabet soup of exclusion lists.
Federal Lists
Two federal databases track individuals and entities excluded from federal healthcare programs and/or are debarred from receiving federal health-related contracts.
The OIG LEIE (The Office of the Inspector General’s List of Excluded Individuals and Entities)
The OIG maintains a list of all individuals and entities that HHS has excluded. Searching the LEIE is a MUST. Any healthcare provider that hires an excluded individual is subject to stiff monetary penalties.
The SAM (The General Services Administration’s (GSA) System for Award Management)
The SAM list is maintained in order to track individuals and entities that are excluded from receiving federal contracts or subcontracts. While SAM.gov does not have the authority to impose financial penalties like the HHS OIG does, it’s still important to check their list since the HHS OIG does not allow healthcare companies to enter into contracts with excluded individuals or entities. Hiring or employing a sanctioned, debarred, or excluded individual excludes a healthcare organization from participating in federal contracts.
The LEIE and SAM lists may overlap but are considered distinct since different organizations maintain them for different purposes. Organizations must include both lists in their pre-hire and ongoing sanctions screens to ensure full compliance.
Other Lists
Beyond these federal databases, it’s also wise to check the following additional lists:
- State Medicaid Exclusion Lists. State lists are published in various formats, and the information included is inconsistent from list to list. Checking these lists is resource-intensive but must be done, as an exclusion in one state means exclusion from every state. Additionally, a whopping half of all state exclusions never make it to the OIG LEIE, meaning that if you’re only checking the LEIE, you’re missing half the story.
- State Medicaid Exclusion Authorities. Medicaid Fraud Control Units (MFCUs) are members of State Attorney General Offices. These teams investigate and prosecute Medicaid fraud and patient abuse or neglect. MFCUs are separate from the State Medicaid agency and maintain their own lists of violators.
- OFAC. The Office of Foreign Asset Control maintains several lists designed to meet foreign policy and national security goals. While the HHS does not currently require healthcare organizations to screen against OFAC lists, organizations can be fined for Medicare or Medicaid transactions involving individuals that are excluded on these lists.
- State Healthcare Fraud and Abuse Lists
- National Practitioner Data Bank (NPDB): This list included info about medical malpractice payments and adverse actions involving healthcare providers and suppliers.
- Global Sanctions and Watch List: This list includes individuals deemed to be national security threats.
Why is sanction screening important?
The number one reason for healthcare sanction screening is patient safety. Sanctioned providers pose an unnecessary and completely avoidable risk to patients. Beyond patient safety, keeping sanctioned providers out of your organization provides the following benefits:
- Compliance: Comprehensive screening complies with federal and state law
- Protection. Screenings protect you from losing your accreditation and your ability to participate in state and federal health programs.
- Lower risk: A robust sanction check policy guards against costly monetary fines and lawsuits.
Accurate provides both pre-hire healthcare sanctions screens and continuous employee monitoring services to ensure that your organization is safe and fully compliant.
Reliable Healthcare Sanction Screenings
Healthcare organizations lose millions of dollars every year to fines and other penalties as a result of failing to effectively screen their employees for sanctions. How can you protect your organization and successfully navigate the complexities of sanction checks for new and existing employees? Accurate is here to help.
Accurate helps healthcare organizations make informed hiring decisions at every level. Talk to a member of our team today about how our reliable, comprehensive healthcare sanction screenings can improve your hiring and keep your organization compliant.
