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Do you know how well your health care organization performs when it comes to monitoring sanction and exclusion lists for your employees and vendors?

There are risks in being found noncompliant by the Office of Inspector General (OIG) and Center for Medicare & Medicaid Services (CMS) by employing or contracting with individuals or entities included on a sanction and exclusion list. The key risks include:

  • Exclusion from participating in federal programs like Medicare and Medicaid, which would be devastating for a health care organization
  • Substantial fines beginning at $10,000 for each item or service rendered by an excluded party
  • Penalties of up to $11,000 per claim plus damages for offenses that fall under the False Claims Act
  • Possible placement in a Corporate Integrity Agreement (CIA), which subjects a health care organization to audits and scrutiny for five years to ensure that the organization takes measures to maintain compliance
  • Criminal fines and jail time for certain charges
  • Damage to an organization’s brand reputation and loss of the trust of patients, employees and the community

This extensive list of penalties shows how important it is for health care organizations to monitor sanction and exclusion lists and remain compliant. Industry experts expect that more stringent requirements will develop at both the federal and state levels regarding publishing and monitoring sanction and exclusion lists. Health care organizations that wish to stay ahead of the curve should check up on the health of their monitoring programs now. Organizations should consider making improvements to their existing processes to be ready for the more exhaustive monitoring requirements that are expected.

As a resource for health care organizations wishing to update their monitoring programs, we’ll take a look at where industry experts believe monitoring requirements are headed. We’ll also recommend some steps to consider in meeting stringent future requirements.

Existing Requirements
The OIG mandates that health care organizations not hire or do business with excluded or sanctioned individuals or vendors. Under the Federal Health Entitlement Plan (FHEP), an individual or vendor sanctioned and excluded in one state is to be sanctioned and excluded from participating in federal programs in all other states. Current OIG requirements also stipulate that organizations check new and existing employees and vendors against the OIG List of Excluded Individuals/Entities (LEIE) and General Services Administration (GSA) Excluded Parties List System (EPLS) at least once a year.

Newer Requirements
Recently the New York State (NYS) Office of the Medical Inspector General (OMIG) announced its recommendation for organizations to check employees against sanction and exclusion lists monthly. While this new requirement applies to New York, industry experts expect other states to follow in introducing similar monthly monitoring requirements. It is also likely that the OIG will release a federal recommendation that mandates checks either quarterly or monthly, instead of annually.

Another new development is the OIG’s recent push at the state level to enforce how organizations upload their sanction and exclusion data to the federal level. Currently there are large gaps in time and information from when a person or vendor is sanctioned at the state level and when that information appears on the OIG LEIE and GSA EPLS.

The OIG is enforcing how states publish data to ensure it is done accurately and timely. The OIG is also making an effort to close any time delays in publishing this information in a larger effort to enforce compliance with its existing rule that a sanction or exclusion in one state is to be upheld nationwide. Five states have also already created their own published exclusion lists and about 17 other states have additional sanction and exclusion data available. It looks like more states may follow this trend and introduce state level sanction publishing requirements.

Recommendations for Getting Ahead of the Curve
Looking ahead to the possibility of more stringent federal and state level requirements, here are some suggestions to consider applying in evaluating your organization’s sanction and exclusion monitoring program:

1. Screen Existing Employees and Vendors
Before overhauling your entire monitoring program, first play catch up. Take your existing roster of employees and vendors and run them against the federal sanction lists and all available state sanction lists. This way you’ll catch any current gaps in your monitoring.

2. Implement a pre-employment monitoring program
Put a pre-employment screening process in place that has a tight filter for sanction and exclusion checks. Be sure this program applies across employees, contract or temporary workers, and vendors.

3. Plan for ongoing monitoring monthly or quarterly
While the current federal regulations recommend screening for sanctions and exclusions no less than annually, that is expected to change to a recommendation for quarterly or monthly sanction checking. New York State now requires organizations to check monthly for newly sanctioned and excluded parties. It is expected that other states and the OIG will follow with quarterly or monthly requirements.

4. Consider an electronic sanction monitoring program
If you don’t already have an ongoing monitoring program, setting one up now will help you to meet the likely coming requirements for monthly or quarterly checks. To further reduce gaps in sanction and exclusion list monitoring and improve efficiency, use a solution that automatically enrolls any person or company from your pre-hire screening program directly into the ongoing screening program. Reputable employment screening providers offer this type of automated monitoring in addition to notifying you in the event that a person or vendor on your roster appears on a sanction or exclusion list.

The clear message for health care employers is that there’s no better time than today to take the right steps to protect your patients, employees and your organization from the inherent risks of employing a sanctioned individual or vendor.

Sanction monitoring white paper

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The HireRight Blog is provided for informational purposes only. It is not intended to be comprehensive, and is not a substitute for and should not be construed as legal advice. HireRight does not warrant any statements in the HireRight Blog. Any statutes or laws cited herein should be read in their entirety. You should direct to your own experienced legal counsel questions involving your organization's compliance with or interpretation or application of laws or regulations and any additional legal requirements that may apply.

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