The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) is promoting "voluntary" compliance programs for the healthcare industry in order to reduce fraud, abuse and waste in the administration of Federal, State and private health plans, as outlined in their Compliance Program Guidance (http://oig.hhs.gov/fraud/complianceguidance.html ). As part of this, OIG recommends pre-screening and ongoing monitoring of all personnel associated with the healthcare organization to ensure they have not been excluded by any Federal agency as a result of fraud.

The OIG states that every healthcare organization is responsible for the actions of all individuals employed within their facilities, and is restricted from hiring or working with any individual or entity that appears on OIG's List of Excluded Individuals/Entities (LEIE).
 
To enforce this, OIG recommends that "all employees, contractors and medical and clinical staff members [be] checked routinely (e.g. at least annually) against government sanctions lists, including the OIG's List of Excluded Individuals/Entities (LEIE) and the General Services Administration's Excluded Parties Listing System."
 
To comply, healthcare organizations need to institute both pre-employment and ongoing screening programs for personnel to check for criminal records or exclusion from OIG and GSA programs. Anyone with a conviction should be prohibited from employment, including existing employees and contractors.

OIG's Compliance Program Guidance addresses a broad range of healthcare entities, from hospitals to hospices, physician practices, and home health agencies. ''Hospitals'' refers to individual hospitals as well as any other organization or individual that owns or operates one or more hospitals.

HIPAA and the Balanced Budget Act impose up to $10,000 in fines for each non-compliant instance with possible assessments reaching three times the amount of claims submitted by the excluded individual or entity. These can be significant - in one example, a nursing agency involved in a wrongful death lawsuit was forced to pay $26.5 million for negligently hiring a nurse who had a criminal record.
 
In addition to fines, OIG often requires non-compliant healthcare entities to institute strict "Corporate Integrity Agreements" as part of the settlement, which can put a significant administrative and operational burden on the organization.

OIG prohibits Federal healthcare program payment for any items or services when provided by excluded individuals or entities. This goes beyond patient care to include administrative and management services as well as expenses for salaries or other employment benefits.
 
To ensure compliance and avoid the risk of fines or loss of Federal health care reimbursement, it is important to screen any individual - employee, volunteer, contractor, or vendor - who is connected with the healthcare organization.

As described in the answer to the previous question, OIG prohibits Federal healthcare program payment for any items or services when provided by any excluded entity. This is not restricted to the organization's personnel, so in order to ensure compliance, healthcare organizations should exercise diligence in screening vendors as well.

Healthcare organizations should not assume that if an employee or contractor refrained from engaging in criminal activity up until the day they were hired, they will continue to do so. This assumption puts compliance at risk and can also expose the organization to workplace violence, fraud and theft.
 
In their Compliance Program Guidance for Hospitals OIG recommends that "With regard to current employees or independent contractors, if resolution of the matter results in conviction, debarment or exclusion, the hospital should terminate its employment or other contract arrangement with the individual or contractor."
 
In their Supplemental Compliance Program Guidance they elaborate further, recommending that "...employees, contractors and medical and clinical staff [be] checked routinely (e.g., at least annually )" against OIG and GSA lists.

There are often concerns about the legal ramifications of ongoing employee screening given the advance consent and disclosure requirements outlined by the Fair Credit Reporting Act (FCRA). Many companies are unaware that provisions in the Fair and Accurate Credit Transactions Act of 2003 (the " FACT Act") override some of these restrictions. Investigations need not be based on suspected employee misconduct, but on a pre-existing, written policy designed to ensure compliance with applicable U.S. Federal, state or local laws and regulations - in this case the OIG compliance guidelines — and/or the company's own criminal conduct policy and other corporate policies.

There are two lists you need to use for screening:

 
•  The OIG List of Excluded Individuals/Entities (LEIE) , which covers parties excluded from Medicare, Medicaid, and Federal Health Programs.
 
•  The General Services Administration's Excluded Parties Listing System (EPLS) , which covers parties excluded from access to all federal programs (not just healthcare).
 
In its OIG Exclusion Authorities Resulting from Public Law ( http://oig.hhs.gov/authorities/docs/exclusion91898.pdf ), circumstances for exclusion are not restricted to fraud in connection with healthcare. Rather, it states more broadly that exclusion can be a result of "Fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct with respect to any act or omission in a program, other than a healthcare program, operated by or financed in whole or in part by any Federal, State or local government agency."
 
Because of this, OIG recommends that personnel be checked routinely against both lists, as noted on page 4876 of its Draft Supplemental Guidance Program.

Those wishing to again participate in the Medicare, Medicaid and all Federal healthcare programs must apply for reinstatement directly with OIG. More information is available on OIG's website at: http://oig.hhs.gov/fraud/exclusions/faq.html#8 .

The OIG list can be found at http://oig.hhs.gov/fraud/exclusions/listofexcluded.html . The GSA list is available at http://www.epls.gov/ .

While at first glance the process seems simple, there are a few issues:
 
•  Screening is generally based on a simple name search, which can lead to missed records or high numbers of false positives. Identifying the right "Carol Smith" can be time-consuming and can result in a hiring or firing mistake.
 
•  The screening process is manual and time consuming. For example, Social Security verification must be done online by going through each name match one at a time. When screening thousands of personnel annually, this becomes unmanageable.
 
•  The OIG and GSA exclusion lists are sometimes outdated, so screening against these lists isn't always enough to protect your organization.

Verified Person provides the most comprehensive, accurate solution available today for OIG/GSA screening. Our Assure solution can solve many of the issues associated with screening while providing significant cost savings. More specifically, our service benefits include:
 
•  More accurate search results: Searches are based on all known aliases and a complete address history to ensure an exact record match.
 
•  Efficiency and cost savings: Our technology-based approach streamlines and automates the entire process, including social security number verification.
 
•  Simplified ongoing screening: Our service runs continuous checks of your personnel automatically and sends a notification when one of these individuals or entities is added to an exclusion list.
 
•  Nationwide criminal search: This enhances the basic service by searching nationwide criminal records to identify infractions that will qualify an individual for OIG exclusion in the near future.

Verified Person's Assure is a comprehensive background screening solution designed to support the pre and post-hire needs of healthcare and other organizations. In addition to OIG/GSA screening, Assure's additional screening services include nationwide, statewide, and county level criminal checks, ongoing criminal screening, employment/education verification, professional license verification, sex offender search, credit history, motor vehicle reports, and drug screening.