1.Why are we required to screen?
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.
2. What screening does OIG expect us to do?
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.
3. Who is required to do this screening?
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.
4. What are the consequences if we don't do this screening?
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.
5. Which personnel should we screen?
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.
6. Do we need to screen vendors as well?
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.
7. Why do we need to screen existing employees - isn't pre-employment screening enough?
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.
8. What restrictions do the FCRA and other laws impose on screening?
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.
9. What lists do we need to use for screening?
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.
10. How do individuals or entities get removed from the LEIE?
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 .
11. Where do I find the OIG and GSA lists?
12. This looks like something we can do ourselves. Why would we outsource?
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.
13. How can Verified Person help us?
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.
14. What other services does Verified Person provide?
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.
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