1 in 8 Employees Found to be Without Proper Licensure Credentials

The following case study is a high-level look into the onboarding process of a ProviderTrust customer, one of the largest post-acute systems in the U.S. with more than 75,000 employees. Given their volume of acquisitions in recent years and decentralized processes, ProviderTrust engaged to solve their data challenges and meet their needs for ongoing license and exclusion monitoring.

The Challenge

Prior to onboarding with the Passport® by ProviderTrust, our client used a different third-party service for exclusion monitoring, and corporate Human Resource and Compliance teams did their best to monitor a decentralized license capture and verification process. In addition, the company had grown into new verticals and business lines and completed major acquisitions. This growth meant that the organization did not have a defined, uniform set of qualifications needed for every position, in each state. We came together to set some clear, definitive goals to measure our success and provide a fresh start.

Partnership Goals

• Complete ongoing license and exclusion monitoring through an automated, easy-to-use application, providing exact matches to reduce the risk and inefficiencies within their current process.
• Eliminate the challenge that our client faced in manually finding all available information within all of the licensing boards across the country and verifying each licensed professional.
• Identify and correct employee license information (including license number, expiration date and issuing state or national certification boards) maintained within their internal data repositories.
• Identify and correct any inconsistencies with employee unique identifying information, such as Name, Address, SSN, NPI, and more.
• Create an authoritative data source where licenses can be stored and updated in real-time to prevent an unlicensed or uncertified person from working within their organization.

How We Helped

• Conducted nationwide federal and state exclusion searches. We completed the initial exclusion matching and verification process of more than 92% of the employees within 24 hours. The remaining 8% of possible name matches were resolved within thirty days.
• Implemented our proprietary DataIQ protocol to determine the completeness of the employee demographics and unique identifying information.
• Provided client with updated employee demographic information including any name or address changes, as well as any inaccurate SSN matches.
• Conducted license verification on all licensed employees from the primary source to create an accurate and complete license dataset for the client.

Exclusions Found

12 exclusions found for 85,805 employees onboarded

$1.2 million in potential fines were discovered (based on industry average)

Primary Source License Verification

ProviderTrust conducted extensive database searching to confirm all licenses provided by our client. When inaccurate information was provided, we would research and locate additional information on all employees, in an effort to validate current licenses. The license verification process was conducted by the line of business to help identify any process changes that may need to be implemented going forward to reduce the risk of ineffective pre-hire information gathering.

29.9% of licenses had issues from the client’s 21,000 licensed providers. Some of the following licensure issues included the following:

• 511 licenses with names provided by the client that did not match primary source licensing board information
• 294 expired licenses
• 4 probationary licenses

Summary

Working with our clients’ Human Resource Information System (HRIS), ProviderTrust was able to capture the required employee demographic information, enabling our team to conduct license verification from each licensing board, as well as to conduct ongoing OIG and state Medicaid exclusion monitoring.

Our Passport® solution’s proprietary DataIQ serves to manage, augment, and organize large amounts of employee data and ensure total compliance. We created a “clean slate” for the client to begin their ongoing monitoring solution with us. They are now confident that they are aware of any license or exclusion concerns and can quickly remediate as needed.