Screening employees for exclusions protects your organization from civil monetary penalties of thousands, if not millions of dollars. These penalties are levied by the OIG against organizations who employ excluded providers or vendors, while receiving payments through a federal health care program.
An exclusion is an action taken by the Department of Health and Human Services, Office of Inspector General (HHS OIG) that prohibits an individual or entity from participating in any health care program that receives federal funds.
A federal exclusion is an action taken against an individual or entity by the OIG that excludes them from participating in Medicare and all other Federal health care programs. State exclusions are actions taken by individual states that prevent an individual or entity from receiving state Medicaid funds.
It’s important to note that not all state exclusions are reported to the OIG, so it’s beneficial to screen employees and vendors through all available federal and state exclusions lists.
Yes, the impact of an exclusion stretches beyond the individual or entity and is applicable to anyone who employs or contracts them while receiving government funds.
Anyone can be excluded by the OIG, even the cashier at your local pharmacy, so it’s important to be proactive and screen all of your employees, not just those who provide patient care.
A state board sanction is a disciplinary action that’s taken against an individual by a state licensing board. The severity of a sanction ranges from placing the provider on probation to a complete revocation of their license.
Screening for state board sanctions ensures that you’re not employing unlicensed or disciplined providers that put your organization at risk for fines and liability.
Employers are responsible for providing patients with safe, reliable care. Those who fail to monitor or take the appropriate action against health care providers who have received a board sanction are fostering an environment that puts patients at risk, which can result in criminal and civil liabilities.
Employees and vendors are submitted through a FACIS® (Fraud and Abuse Control Information System) search, which screens them against thousands of disciplinary records collected from primary sources, on health care providers who have had an adverse action taken against them by a federal or state government regulatory body or state-licensing board.
