Exclusion & Sanction Screening FAQ
Exclusion & Sanction Screening FAQ
In short – yes. Verifying the clearance of associations with excluded parties is a required regulatory compliance item. Enforcement is overseen and carried out by HHS OIG.
As explained by HHS, “OIG has the authority to exclude individuals and entities from Federally funded health care programs pursuant to section 1128 of the Social Security Act (Act) (and from Medicare and State health care programs under section 1156 of the Act) and maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals/Entities (LEIE).”
The industry standard for exclusion screening is that it should be carried out on a monthly basis. This supports updates to the LEIE and other exclusion/sanction authorities that occur monthly (or more often). As a result, Venops fully supports and conducts monthly exclusion screening to minimize the liability for CMPs.
From OIG HHS:
“Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP)… To avoid CMP liability, health care entities need to routinely check the LEIE to ensure that new hires and current employees are not on the excluded list.”
As a Medicare, Medicaid, or Tricare provider – applicable payees including physicians, employees, and even vendors must be crosschecked against the OIG List of Excluded Individuals and Entities. Billing under these programs while associated with excluded parties can result in compounded civil monetary penalties.
Early on, Venops adopted a comprehensive approach to track all applicable exclusion and sanction authorities in addition to the List of Excluded Individuals and Entities (LEIE). Since then, it has become the industry standard. Why? The need for monthly screening arises not only from staffing changes, but also from the dynamic nature of the exclusion and sanction authorities themselves. Many of them change monthly – some weekly – and those authorities are monitored in real time by Venops.
Providers and contracting entities have an affirmative responsibility to routinely verify the exclusion status of individuals and entities and maintain a record.
Violations and Civil Monetary Penalty (CMP) amounts of the OIG LEIE fall under the False Claims Act (FCA). Details of CMP assessment include:
- Fines for each item or service furnished by the excluded individual or entity.
- An assessment of up to three times the amount claimed (the amount paid to the health care organization by the government program going back as many as 6 years).
- Government Funded Program exclusion
CMPs are codified and adjusted for inflation annually (typically in November). The latest adjustments can be referenced at 45 CFR § 102.3 as well as
45 CFR § 1003.210.
Venops mitigates compliance risk with automated exclusion screening through all applicable exclusion and sanction lists.
There are multiple exclusion and sanction lists tracked by Venops. While the federal OIG LEIE and GSA SAM are the most recognized exclusion lists, the majority of states have additional exclusion lists that should be tracked every month. Additional exclusion and sanction authorities are also included with Venops screening, such as the lists for OFAC, Tricare, and CMS Opt Out affidavits. A full list of exclusion authorities tracked by Venops can be found in our knowledge base – available to our members.
The Venops exclusion screening process is straightforward:
- An encrypted upload from your Venops dashboard provides an “exclusion screening template” with the individuals and entities you want to screen.
- Venops accurately crosschecks your list against a direct-source exclusions database of every applicable exclusion/sanction authority.
- Complete exclusion clearance investigations are included with a premium membership. A complete exclusion screening record is created to show there are no excluded parties affiliated with your organization.
- Our free model instantly identifies all possible exclusion matches by name and source. The Venops knowledge base provides a concise guide to easily clear any possible matches found.
- Premium and basic free memberships both include unlimited exclusion screening.
- Premium membership includes Autopilot™ monthly screening. The Venops system remembers every name previously screened and re-checks each of them automatically against the new updated exclusions database. This provides you with an updated, current exclusion report every month without fail.
This is a statement we hear often enough to address it in our FAQ. Yes – exclusion screening still applies. This is why:
The OIG mandate not only includes exclusion screening to identify excluded parties, but also the requirement to maintain an appropriate record. Your records of routine screening will do much to prove due diligence during any audits that occur – and Venops covers this need with both membership options offered.
Take a closer look by clicking the “Memberships” button above to see a graph showing a side-by-side comparison for each membership level. No registration required.