Situation:

Recent statutory enactments have strengthened and expanded the Office of the Inspector General’s (OIG’s) authority to exclude individuals and entities from participation in Medicare, Medicaid, and other Federal health care programs. The OIG is able to impose civil penalties for misconduct related to Federal health care programs (Sections 1128 and 1128A of the Social Security Act) . The effect of an OIG exclusion is that Federal health care program payment may not be made for any items or services (1) furnished by an excluded individual or entity, or (2) directed or prescribed by an excluded physician.

Program payments will not be made to any entity in which an excluded individual is serving in any capacity, for any services furnished, ordered, or prescribed on or after the effective date of the exclusion. In addition, no payment may be made to any business or facility, e.g., a hospital that submits bills for payment of items or services provided by an excluded party, directly or indirectly.

The OIG often negotiates compliance obligations in the form of Corporate Integrity Agreements (CIAs) with health care providers as part of the settlement of Federal health care program investigations arising under a variety of civil false claims statutes. A provider or entity consents to these obligations as part of the civil settlement and in exchange for the OIG's agreement not to seek an exclusion of that health care provider or entity from participation in Federal health care programs. One of the main elements of the more comprehensive CIAs is a requirement to “Restrict employment of ineligible persons” - meaning that employee backgrounds must be checked periodically for sanctions.

Solution:

Global Compliance’s SanctionScreen™ service assists healthcare clients in identifying individuals who have been sanctioned or otherwise excluded from participation in federally funded health care programs. Health care providers can upload employee lists that are compared to a cumulative searchable database to verify whether employees appear on these exclusion lists. The database lists are formulated from the following sources and are downloaded monthly:

• Department of Health and Human Services Office of the Inspector General (OIG) List of Excluded Individuals/Entities
• Excluded Parties Listing System (EPLS)

Screening results are available within 24 hours of list submission to accommodate human resources processes. Reports are output in a file format readable by Excel and other spreadsheet software to enable internal compiling, sorting, and charting and are archived for one year to assist with documentation.

Outcome:

SanctionScreen™ enables healthcare providers to implement an exclusion review program to meet government requirements, avoid civil monetary penalties and minimize liabilities in hiring and employment processes. For those health care organizations currently under Corporate Integrity Agreements, SanctionScreen can help fulfill the mandates of the Office of Inspector General to screen or check all employees periodically for sanctions.