If you are a healthcare Human Resources professional at your organization, then most likely you are already familiar with the mandates to conduct pre-employment background checks (pre-hire screening) on applicants before they join your company. But what about post-hire and monitoring your employees once they’ve been on-boarded?

Most likely your team is either collaborating with the Compliance department or doing the work on post-hire ongoing employee monitoring as well. This is no daunting task, and we often see the hours stack up when healthcare organizations are relying solely on individual searches or an internal process utilizing spreadsheets or other traditional tools.  

So where do you begin? Don’t stress, we’ll break down how to effectively screen and monitor your employees from start to finish! In this article, we’ll discuss some of the benefits of separating your pre-hire and post-hire solutions to create a better framework for success, help mitigate risk, and provide a safety net for unknown data.

What are the Differences Between a Healthcare Pre-Employment Background Check and Ongoing Employee Monitoring?

We get this question quite a bit, so we hosted a webinar about it with a pre-employment background check expert – Pre-employment Screening vs. Ongoing Exclusion Monitoring! To learn more, you can check out the video below.

Post-Hire Ongoing Healthcare Employee Monitoring is Essential

Our team at ProviderTrust is solely focused on ongoing employee monitoring. Our mission is to keep partners updated with all of the information that could be presented post-hire that could affect their employees and vendors qualifications/standing. We believe that providing a full employee profile does not stop with a background check and occasional check-ins on the individual’s license or exclusion status.

Monitoring primary source resources with better search tools can have a drastic difference when it comes to a more complete timeline of work history and experiences for each employee. These updates also have to be timely enough to catch a potential problem from becoming a larger compliance issue that could lead to fines and penalties, or worse. Knowing the status of each employee on a consistent and frequent basis is essential to maintaining the overall quality of service and an effective compliance program. Given the frequency of so many mergers and acquisitions, many healthcare organizations inherit risk from a new partnership and have to resolve issues of insufficient screening practices in their current population

Insufficient Healthcare Employee Data

Many times, HR and Compliance professionals are utilizing the information provided to them by the employee, and do not have the proper tools to quickly and effectively identify outstanding disciplinary actions or sanctions in other states. What if the employee gave its employer false information in an effort to fool them or circumvent finding a public record or license issue? For example, you may check a license of an applicant pre-hire and believe you are good-to-go given their credentials. Once they are hired, you may be alerted that the individual could have disciplinary actions or sanctions against them, or that they’ve been excluded from providing services compensated with federal dollars (Medicare, Medicaid).

Further, what if the employee gave you their maiden name knowing that their exclusion or license action is under their married name, or vice-versa? If you take a look at the real example below, you can see how easy it is for a name and in this case (an exclusion) to slip through the cracks when it comes to employee monitoring. 

Healthcare License Exclusion SAM OIG LEIE

Unfortunately, in our current healthcare environment many inefficiencies, discrepancies, and inaccuracies are present when it comes to tracking the lifecycle of healthcare employees. Given today’s mobile workforce, it’s essential to use smarter solutions to fill in the gaps in employee data and primary source information. Better and smarter monitoring tools have evolved to find infractions through a variety of unique identifiers, such as Social Security Numbers (SSN) or National Provider Identifiers (NPIs). Healthcare professionals find it hard to find supplemental information on employees and healthcare organizations on their own or solely from government data.  That’s where we come in!

ProviderTrust helps deliver the unknown data post-hire that keeps you compliant and in control. Have you ever tried to look up healthcare sanctions on your own? You might be surprised by all the formats they come in, and how frequent or infrequent these are updated or reported to the state and the federal government

Benefits of Separating Your Healthcare Pre-hire Screening and Ongoing Employee Monitoring Solutions

At ProviderTrust, we focus our attention, resources, and expertise in conducting ongoing employee and provider monitoring to help our customers stay compliant and become aware of new changes through an effective alert system. Background checks from “all-inclusive” companies are nothing new; we know that many competitors offer solutions for pre-hire screening with additional exclusion screening. However, if we may brag a bit – we think our solutions stand out, and the reason why is our approach to smarter data and our comprehensive dashboards. We believe our team can deliver post-hire ongoing employee monitoring better than an all-inclusive option. 

Think about it, do you remember the last time you chose to go along with a business that offered that they were experts in everything?

Did it turn out well? Or how about the last vacation you spent and “everything was included”? At some point, one of the incentives or services was probably not optimal given they tried to manage or control everything all at once. So our approach is a little different, but we believe we are continuing to master data aggregation and “information scrapping” for a large part of unknown healthcare data. Our unique and advanced sorting algorithms help find important information that other vendors miss

Smarter healthcare data is crucial in better understanding employee and provider history and upholding compliance standards as they relate to federal guidelines and regulations. Sometimes the biggest risk or fear is the fear of the unknown or lack of access to information to make better decisions. In this case, we’ve got you covered and think two solutions are better than one. Here are a few reasons why…

  1. Conducting the right background check and utilizing the established networks of courthouse retrievers is key to compliant pre-employment screening.
  2. A one-time search of HHS OIG-LEIE at pre-hire is not sufficient, based on CMS and HHS OIG Guidelines. Monthly monitoring is key to avoid civil fines and monetary penalties.
  3. Certain elements of an initial background check are static (verification of SSN, Education Verification, Employment Verifications, etc..). However, a criminal record leading to a sanction/disciplinary action, license status and/or exclusion status can change monthly.
  4. Background screening firms typically offer a resale of a wholesale database search of a third-party exclusion dataset. This creates a markup fee and lack of quality control. Further, most background screening companies take 90-120 days to review any possible records to determine matches.  
  5. Ongoing employee monitoring solutions and expertise in matching primary source records is a specialty and requires smarter technology with additional datasets. This is where a dashboard and notification system is essential to alert you of information you might be missing for an employee.
  6. Most background screening companies do not contain or search all available state Medicaid exclusion lists, nor do they search against them as a part of their core services. Many of these companies do not utilize or have inferior data-scraping tools.
  7. Some background check companies simply search exact name only or conduct “fuzzy match logic”. With smarter tools and data, it becomes much easier to ensure cross-referencing and finding records that may be tied to a maiden name, former last name, or tied to the same SSN.
  8. Some background screening companies do not indemnify against any claims for a missed record or untimely reported record.
  9. We like to think of ourselves as data scientists, and in so doing we are always learning more and getting better at our process for matching and identifying holes in your information gaps whether it be SSNs, NPI, or sanction records. Our smarter data and alert process are more efficient and effective for organizing and presenting large data sets that can be hard to obtain.
  10. Utilizing a separate employee monitoring company, you will gain a check-and-balance assurance that the pre-employment screening solution was accurate and giving you the best results.

Real-Time Dashboards and Monthly Exclusion Monitoring

Since an employer is liable for civil fines and monetary penalties up to $20,000 per item claimed plus treble damages for submitting payments or a bill for services for an excluded individual or entity, the employer should implement monthly monitoring as a best practice. The average fine for employing an excluded individual in 2017 was $126,738. This would include, at a minimum, a monthly check against the following data sets on all staff, referring physicians, and vendors/third parties:

  1. License verification and management (for positions requiring licensure)
  2. Disciplinary actions associated with an individual or license (sanctions)
  3. HHS OIG-LEIE (exclusions)
  4. SAM.gov Database (debarments)
  5. State Medicaid exclusion lists (currently 42 states)
  6. Opt-out lists (CMS Opt out Affidavit)

Other important references or databases you should possibly check to lower your risk are the following:

  1.     DEA Registration
  2.     OFAC (for prescribers)
  3.     SSA-DMF

Having a comprehensive dashboard that can manage large data sets and be adaptable to your employee data for each individual profile is essential to implementing efficient workflows and verifying each employee status. An active dashboard allows for more visibility, automated notifications, and most importantly – superior data verification and search tools working to benefit your team.

Mitigate Your Risk and Organize Your Employee Data Better

Ongoing employee monitoring meets one of the Seven Elements of an Effective Compliance Program as outlined by HHS OIG and provides an employer with the best defense against civil and monetary penalties levied by states and/or the HHS Office of Inspector General (OIG). The OIG and many states update their exclusion lists on a monthly basis and if a provider does not monitor these lists on an ongoing basis, they introduce potential liability for the submission of false claims and the enforcement of sanctions by state Medicaid Fraud Control Units and HHS OIG.

A healthcare organization can gain added assurance and create a checks-and-balance system to ensure that (1) proper searches have been conducted during the lifespan of the employee, (2) monthly monitoring of exclusions and license changes are searched and dealt with in a timely manner to avoid costly civil and monetary penalties, and (3) a layer of protection is added by utilizing an expert in pre-employment screening as well as a post-hire ongoing employee monitoring expert.

You can never be too careful when it comes to choosing pre-hire and post-hire solutions. Shifting your risk is one effective measure of compliance best practice and risk aversion.


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Written by Michael Rosen, ESQ

ProviderTrust Co-Founder, mrosen@providertrust.com

Michael brings over 20 years of experience founding and leading risk mitigation businesses, receiving numerous accolades such as Inc. Magazine’s Inc. 500 Award and Nashville Chamber of Commerce Small Business of the Year.

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