Healthcare Exclusion Checks: New Year, New Opportunities

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It is a new year for healthcare industry employers, and with the refreshing new energy, comes the responsibility of ensuring healthcare exclusion monitoring is complete and up-to-date.

Healthcare exclusion checks exist for one primary reason: to determine whether or not a person is excluded from participation in providing services for employers or at facilities who receive federal funds.

According to the OIG website, individuals and entities on the U.S. Health and Human Services Office of the Inspector General (OIG) List of Excluded Individuals and Entities (LEIE) are typically excluded for a number of reasons including, but not limited to the following:

Medicare or Medicaid fraud, offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs; patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances … misdemeanor convictions related to health care fraud other than Medicare or a State health program, fraud in a program (other than a health care program) funded by any Federal, State or local government agency; misdemeanor convictions relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances; suspension, revocation, or surrender of a license to provide health care for reasons bearing on professional competence, professional performance, or financial integrity; etc.

Hiring or continuing to employ a person or persons who are excluded from Medicare, Medicaid and other federally-funded health care programs can pose significant risk to healthcare employers. Without conducting healthcare exclusion checks, employers run the risk of hiring or continuing to employ or contract with an excluded professional, which, according to an OIG Special Advisory Bulletin, means that no federal health care program payment may be made for any items or services furnished by, or at the medical direction/prescription of an excluded person. Additionally, employing or contracting excluded individuals may result in numerous penalties.

With the advent of the New Year, now is the perfect time for employers to be diligent and re-evaluate their screening processes.

Healthcare exclusion checks should always be performed prior to hiring a candidate. Additionally, industry best practice recommends employers screen current employees on a monthly, or at minimum, quarterly basis to ensure all staff members are in good standing to provide services for federally-funded programs. In addition, some states have additional excluded-parties databases and require additional screening to ensure compliance with state regulations for participation in providing services under specific programs.

A-Check Global partners with clients in the healthcare field to build comprehensive pre-hire and ongoing screening programs. These programs often include continuous exclusion list monitoring to aid in mitigating risk and ensure employers maintain a quality, qualified workforce.

If your company is interested in learning more about healthcare exclusion monitoring or establishing a screening program, please contact A-Check Global through our contact page, or by phone at 877-345-2021.

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