Compliance with HHS-OIG, CMS, and other healthcare regulations involves monthly (or continuous) exclusion monitoring of the OIG LEIE, SAM.gov, and all state Medicaid excluded, sanctioned, or terminated provider lists. But many healthcare organizations committed to patient safety go beyond the minimum required monitoring and build complete profiles of providers’ history of care delivery. Best practice would also include searching for board actions and disciplinary infractions imposed by a state licensing board.
Our Sanctions Screening package can be easily added to any Passport account with exclusions or license monitoring. Here are the top benefits our clients see after adding sanctions screening to their ongoing monitoring program.
1. Complete Provider Profiles
Comprehensive sanction screening delivers insight into administrative or disciplinary actions for a provider or one of their licenses. For example, if a provider had a license revoked or suspended in one state and then moved to a different state and obtained a new license, that action could avoid detection in typical pre-hire screening, but would show up in ProviderTrust’s comprehensive sanctions screening.
This insight is powerful because it allows your organization to better answer questions about a person’s ability to deliver care by creating a holistic profile of a provider. When you have the full picture of a provider, you can make more informed decisions about eligibility and risk.
Whether the sanction resulted from an allegation of patient abuse or negligence, fraudulent billing or overprescribing or an administrative issue, you’ll be empowered to make the best decision for your organization.
2. Reduce and Prevent Fraud, Waste, and Abuse (FWA)
We all know healthcare fraud, waste, and abuse costs Americans billions of dollars annually. But most of the time, there are clues about bad actors’ behavior before they make headlines.
Comprehensive sanctions screening catches the often hard-to-find paper trail of questionable behavior that can be missed by traditional background check screening and exclusion monitoring solutions. With no data or reporting consistency between thousands of disciplinary and licensing boards, sanctions and disciplinary actions can be published in online board directories, email updates, or offline newsletters and meeting minutes. Comprehensive sanctions screening surfaces any red flags in someone’s past work history. So we can tell you if your Jane Doe, LPN in Arizona is the same Jane Doe, RN who had a license revoked in Ohio five years ago. In some cases, there are even enough identifiers that might lead to the connection of a previous or maiden name record belonging to the same provider.
While previous fraud, waste and abuse may not always predict future behavior, it often can. We believe better and smarter data is the key to fighting fraud, waste, and abuse and keeping patients safe.
3. Predictive Insight for Exclusions
We know that almost 50% of exclusions on the OIG List of Excluded Individuals and Entities (LEIE) are derived from a sanctioned or revoked license. This means that the exclusion triggering event was first reported by a disciplinary board action from/to a licensing board and documented in a hearing. The time between the allegation and the LEIE exclusion can be upwards of 18 months, and the sanction record may be from a different source than the license board, such as a newsletter or minutes from a meeting where an action was taken against the provider.
With comprehensive sanctions screening, you can know about the potential compliance issue before an exclusion is ever issued, saving your organization from OIG fines, penalties, and recoupment.
4. Improve Alignment Between Compliance and HR
The insight your organization receives from sanctions screening is invaluable not only for compliance purposes but also in providing insight to HR teams about your employee populations. And with Passport’s integration capabilities, you can surface sanctions alerts within your HRIS system, creating one source of truth and helping Compliance and HR teams stay on the same page.
5. Better Protect Patients
Sometimes when we’re talking about healthcare compliance and sanctions, it’s easy to forget the very real human effects. People who deliver care come into contact with patients, and the actions of sanctioned and excluded individuals can have real (and sometimes dire) consequences.
At ProviderTrust, our purpose is to protect patients, and we believe smarter healthcare data is the way to do just that. Our comprehensive healthcare sanctions screening solution is the best possible protection for your organization and the patients and communities you serve.