Healthcare Sanction Reports
Is An OIG/GSA Search Enough?
For many years the United States government has worked diligently to protect individuals such as the elderly and those seeking patient care. The ultimate objective is to clean-up the healthcare system by identifying and eliminating fraud, waste and abuse, and providing a mechanism for audits, inspections and investigations.
One of the primary goals of the Department of Health and Human Services, in conjunction with the Office of Inspector General (OIG) and the General Services Administration (GSA), was to create and maintain a sanction list of individuals and entities called the “List of Excluded Individuals/Entities.” OIG and GSA searches are vital for healthcare providers. The OIG & GSA databases include individuals and businesses excluded or sanctioned from participating in Medicare, Medicaid, or other federally funded healthcare programs. These sanction lists include entities and individuals that have been convicted for program related fraud and patient abuse. Individuals that have licensing board sanctions, suspended licenses, and default on Health Education Assistance Loans are also included. Healthcare organizations must check these two databases on a pre-employment and annual basis to be within federal compliance.
If an organization has an affiliation with an individual or entity included on one of the sanction lists, they may be forced to pay back all Federal funds back to the date the individual or entity became affiliated with the organization. This could mean hundreds of thousands in lost revenue depending on the length of the violation. In addition, Civil Monetary Penalties (CMPs) of up to $10,000 per violation can also be levied. Continued violations could even mean that a healthcare organization be denied to receive any government funds from Medicare, Medicaid or any other government supplemented program, virtual putting them out of business.
According to an OIG Special Advisory Bulletin issued in 1999, “no federal program payment can be made to cover an excluded individual’s salary, expense or fringe benefits, regardless of whether they provide direct patient care.” This is a very broad statement and could include anyone working directly or indirectly within healthcare: hospitals; clinics; doctor’s offices; home healthcare agencies; insurance providers; and other healthcare program management firms. Obvious positions to be checked include: doctors; nurses; patient care specialists; Technicians; or anyone else involved in direct patient care. There are actually over fifty types of positions that are affected. Positions such as Maintenance Personnel, Administrators, Pharmacists, Medical Billing Specialists and any other support staff are included within this mandate. Basically anyone working within the walls of a healthcare organization must be checked. What many Healthcare Administrators forget is that compliance includes any outside or contract service performed, not just staff members within the organization. Contracts that include Ambulance Driver’s, Paramedics, Dispatchers, Social Workers, Pharmacies, Drug Stores, Medical Equipment providers, or even general supply companies that provide contracted goods and services, also fall under this mandate and need to be checked.
These federal databases only reflect the current status of an individual or entity and provide no historical data. On a state level, most states maintain their own database with state specific sanction information that may not be updated into the OIG and GSA. These state exclusion and sanction lists pertain to state fraud, along with medical license information which may reflect a suspended or revoked license. The only way to ensure that this is not the case with your candidate is to conduct a multi-state search, in addition to the OIG/GSA search. Enhanced due diligence and risk mitigation can only be achieved by a thorough search of both federal and multiple state databases.
EBI offers the following three levels of screening to enhance due diligence and risk mitigation:
This search includes OIG/GSA and other federal sources, including FDA debarments, DEA restrictions and TRICARE (military actions). This search meets minimum federal requirements as outlined by the federal mandate. This level of search is only recommended for low-risk employees and contractors not involved with patient care.
This search includes a Level One, plus a check of statewide sanctions in one state. This search meets minimum federal requirements and provides limited state-licensure protection (one state only). This level is ideal for moderate-risk employees, contractors and administrators.
This search includes all of Level Two, plus a check of statewide sanctions in all fifty states. This search exceeds minimum federal requirements and offers much broader business risk management for existing employees, vendors and contractors. It’s a must for high-risk individuals and contractors: anyone directly involved in patient care; or with direct access to patients, such as physicians, nurses, physical therapists, pharmacists, and specialized contractors.
With EBI, our Healthcare Sanctions Report (HSR) is comprehensive and easy to use. With one click of a button, EBI provides multi-level options of screening against a comprehensive and historical database of adverse actions and sanctions. This includes more than 600,000 adverse records of debarred, disciplined, excluded or sanctioned individuals and entities. HSR reports are searched over more than 800 sources. We can even provide batch processing and yearly program management for proper federal and state compliance. Let EBI be your healthcare due diligence provider.
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All information contained herein is provided by Employment Background Investigations solely for the convenience of its clients. EBI is not providing legal advice or counsel and nothing provided on this document should be deemed as legal guidance or advice. Readers should consult with their own legal counsel to determine their legal responsibilities or if they have questions on any information provided by EBI.