Exclusion Screening: 5 Best Practices for Your Facility
Healthcare facilities are responsible for providing safe patient care to the people they serve. Employing high-quality professionals is key to patient wellness — but how can companies ensure that job applicants haven’t previously been reprimanded for healthcare-related offenses?
Facilities can enact an exclusion screening policy to flag individuals who have violated federal or state laws in the patient care setting. These violations could include Medicare and Medicaid fraud, illegal distribution of medications, patient abuse, and neglect.
Below, we’ll dive into the details of this approach, explain why it’s important for your facility, and provide five best practices for ensuring the protection of your patients.
What Is Exclusion Screening?
In order to deliver quality care, facilities must be able to tell if a potential employee has ever committed a crime in the medical field. This method of screening, also known as exclusion monitoring, is the process of confirming that an employee or contractor is not prohibited (i.e., “excluded”) from participating in federally funded programs.
The Office of the Inspector General (OIG) exclusion search prohibits practitioners who have been convicted of previous healthcare-related crimes from receiving money from Medicare and Medicaid. These doctors, nurses, and administrators are put on a List of Excluded Individuals/Entities (LEIE) for easy lookup.
Additionally, 45 states maintain their own Medicaid exclusion lists. Healthcare providers who have violated state laws but not necessarily federal laws are reported on these databases. For example, the New York Office of the Medicaid Inspector General (OMIG) exclusion list contains names of individuals who have violated New York laws but might not be on the main federal lists.
When Should Facilities Conduct Screenings?
Prior to (and periodically after) the hiring of any new employee, companies are legally required to confirm that each staff member is allowed to provide medical treatment. Some payers even require facilities to conduct monthly screenings, since this is how often the OIG updates the LEIE. In addition to a normal background check, facilities will enter the individual’s name into federal and state exclusion databases to verify that the employee is cleared to work.
Why Is Exclusion Monitoring Important?
By doing their due diligence and preventing repeat offenders from harming their patients, each facility maintains responsibility for ensuring safe and ethical treatment. Any company caught hiring someone on the LEIE could be subject to hefty fines of up to $10,000 for each item or service furnished by the excluded individual, an assessment of up to three times the amount claimed, and possible exclusion from federal healthcare programs.
5 Best Practices for Conducting Exclusion Screening
By conducting exclusion screening, healthcare facilities can ensure the best possible care for their patients and protect themselves from liability. Here are five best practices that can help you effectively incorporate this process into your security protocols.
1. Familiarize Yourself With Your Resources
Healthcare compliance officers can access federal and state databases to check the status of every new and existing employee. To ensure legal compliance, healthcare businesses should do a thorough screening of federal exclusion lists and any applicable state lists.
Many search engines claim to perform an in-depth analysis of employee qualifications, making it complicated to know exactly where to begin. To help you get started, we’ve listed three main resources that companies reference when clearing employees.
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| List of Excluded Individuals/Entities (LEIE) | Run by the Office of Inspector General (OIG), this is the primary federal exclusion list for individuals working in healthcare. |
| System for Award Management (SAM) Database | This resource is managed by the General Service Administration (GSA) and contains debarment listings from various federal institutions. While SAM exclusion criteria is not specific to the healthcare industry, it’s important to search before hiring contractors or vendors. |
| State Medicaid Exclusion Lists Database | As mentioned earlier, each state also maintains its own Medicaid exclusion list. You can find your state’s specific list using this state-by-state database. This links to every state’s exclusions, from the Illinois sanctions list to New York’s OMIG exclusion list. |
2. Explore Name Variations and Other Identifiers
Federal and state lists include the names of the individuals as they were listed at the time of the offense. Including previous names, nicknames, and other patient identifiers (birthdate, Social Security numbers, addresses, etc.) in your search can ensure accurate results.
3. Screen Upon Hiring, and Monthly Afterward
Facilities need to perform exclusion screening for every newly hired employee, contractor, and vendor. The Centers for Medicare and Medicaid Services (CMS) recommends checking monthly for verification of current staff’s compliance. Routine screening is important, as poor oversight could lead to detrimental patient harm and substantial fines for your facility.
4. Consult Legal Counsel
If a current or prospective employee comes up on an exclusion list, you should speak to a lawyer. It’s important to follow the necessary steps for reporting, and the employee will likely need to be terminated promptly, a decision and process that should be reviewed by counsel. Documenting that you handled the situation in a timely manner is necessary, so make sure to save evidence (screenshots, time stamps, emails, and documents) for potential legal review.
5. Hire a Chief Compliance Officer to Help
Periodically reviewing employee compliance can take considerable amounts of time, but hospital management is often swamped with many other important tasks. Consider appointing a member of staff to manage the duties of exclusion list screening, auditing, and reporting.
A chief compliance officer can efficiently process and organize the data necessary to verify that your team members are allowed to work. They can keep documents centralized and secure, and are aware of laws pertaining to employment. Prioritizing safety and accountability within the leadership on your executive team can not only minimize your legal exposure, but also help you to deliver safe, quality care to your patients.
Discover More Ways to Ensure High Quality Care
Now that you understand the process of OIG exclusion screening, you’re probably looking to find more tips to improve the quality of care at your facility. Don’t miss out; find more strategies and best practices by following our free IntelyCare newsletter.
Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.