Frequently Asked Questions

Section 1: General FAQ

In 1977, in the Medicare-Medicaid Anti-Fraud and Abuse Amendments, Public Law 95-142 (now codified at section 1128 of the Act), Congress first mandated the exclusion of physicians and other practitioners convicted of program-related crimes from participation in Medicare and Medicaid. This was followed in 1981 with the enactment of the Civil Monetary Penalties Law (CMPL), Public Law 97-35 (codified at section 1128A of the Act), to further address health care fraud and abuse. The CMPL authorizes the Department and OIG to impose CMPs, assessments, and program exclusions against any person that submits false or fraudulent or certain other types of improper claims for Medicare or Medicaid payment. Claims submitted by an excluded person for items or services furnished during the person’s exclusion violate the CMPL.

To enhance OIG’s ability to protect the Medicare and Medicaid programs and beneficiaries, the Medicare and Medicaid Patient and Program Protection Act of 1987, Public Law 100-93, expanded and revised OIG’s administrative sanction authorities by, among other things, establishing certain additional mandatory and discretionary exclusions for various types of misconduct. The enactment of the Health Insurance Portability and Accountability Act (HIPAA), Public Law 104-191, in 1996 and the Balanced Budget Act (BBA) of 1997, Public Law 105-33, further expanded OIG’s sanction authorities. These statutes extended the application and scope of the current CMP and exclusion authorities beyond programs funded by the Department to all “Federal health care programs.” BBA also authorized a new CMP authority to be imposed against health care providers or entities that employ or enter into contracts with an excluded person to provide items or services for which payment may be made under a Federal health care program.

Since the publication of the 1999 Bulletin, various statutory amendments have strengthened and expanded OIG’s authority to exclude individuals and entities from the Federal health care programs. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and the Patient Protection and Affordable Care Act of 2010, as amended by the Health Care Education Reconciliation Act of 2010 (ACA), expanded OIG’s exclusion waiver authority. The ACA also modified and expanded OIG’s permissive exclusion authorities and amended the CMPL by adding a new provision that subjects an excluded person to liability if the person orders or prescribes an item or a service while excluded and knows or should know that a claim for the item or service may be made to a Federal health care program. For more information, please go to http://oig.hhs.gov/exclusions/background.asp

As a Medicare, Medicaid, or Tricare provider - applicable payees including physicians, employees, and even vendors must be routinely 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.  

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. The latest adjustments can be referenced at 45 CFR § 102.3 as well as
45 CFR § 1003.210.

The Venops exclusion screening process is straightforward:

  1. An encrypted spreadsheet uploaded from your Venops dashboard provides an "exclusion screening template" with the individuals and entities you want to screen.
  2. Venops accurately crosschecks your list against a direct-source exclusions database of every applicable exclusion/sanction authority.
  3. 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.
  4. 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. This option is best for smaller covered entities with a staff that doesn't change very often.
  5. Premium and basic free memberships both include unlimited exclusion screening.
  6. 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.

If you're interested in taking a closer look, create a free Venops account in minutes at no risk. Here's how:

  1. Click "Register for Free" above, then click the "Signup" button to create your account.
  2. Try a basic membership if you prefer. You can easily upgrade to premium any time.
  3. Download the template from your new Venops dashboard, enter a few names, and get exclusion screening results instantly.

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.

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 Medicare and/or Medicaid sanctioned provider lists that should also be screened.

Additional exclusion and sanction authorities are also included with Venops screening, such as the lists from OFAC, Tricare, and the CMS Opt Out affidavits. A full list of exclusion authorities tracked by Venops can be found in our knowledge base.

If you're interested in taking a closer look to learn more, create a free Venops account in minutes at no risk. Here's how:

  1. Click "Register for Free" above, then click the "Signup" button to create your account.
  2. Try a basic membership - you can upgrade to premium any time.
  3. Download the template, enter a few names, and view your exclusion screening results instantly.

Venops is known in the healthcare industry as a reliable steward of sensitive information critical for carrying out compliance services, and trust is our most cherished principle. Venops uses industry standard encryption with SOC 2 elements to protect the data shared for services fulfillment. Additional protocols are in place to further reduce risk.

Your privacy is critically important to us.

It is Venops, Inc.'s policy to respect your privacy regarding any information we may collect while operating our website. This Privacy Policy applies to https://www.venops.com/ (hereinafter, "us", "we", “our”, or "https://www.venops.com/"). We respect your privacy and are committed to protecting personally identifiable information you may provide us through the Website. We have adopted this privacy policy ("Privacy Policy") to explain what information may be collected on our Website, how we use this information, and under what circumstances we may disclose the information to third parties. This Privacy Policy applies only to information we collect through the Website and does not apply to our collection of information from other sources.

This Privacy Policy, together with the Terms and conditions posted on our Website, set forth the general rules and policies governing your use of our Website. Depending on your activities when visiting our Website, you may be required to agree to additional terms and conditions.

Website Visitors

Like most website operators, Venops, Inc. collects non-personally-identifying information of the sort that web browsers and servers typically make available, such as the browser type, language preference, referring site, and the date and time of each visitor request. Venops, Inc.'s purpose in collecting non-personally identifying information is to better understand how Venops, Inc.'s visitors use its website. From time to time, Venops, Inc. may release non-personally-identifying information in the aggregate, e.g., by publishing a report on trends in the usage of its website.

Venops, Inc. also collects potentially personally-identifying information like Internet Protocol (IP) addresses for logged in users and for users leaving comments on https://www.venops.com/ blog posts. Venops, Inc. only discloses logged in user and commenter IP addresses under the same circumstances that it uses and discloses personally-identifying information as described below.

Gathering of Personally-Identifying Information

Certain visitors to Venops, Inc.'s websites choose to interact with Venops, Inc. in ways that require Venops, Inc. to gather personally-identifying information. The amount and type of information that Venops, Inc. gathers depends on the nature of the interaction. For example, we ask visitors who sign up for services at https://www.venops.com/ to provide a username and primary/secondary email addresses. This allows accurate communication within the scope of notifications relating to our services or information about our services.

Security

The security of all personal information is important to us, but remember that no method of transmission over the Internet, or method of electronic storage is 100% secure. While we strive to use commercially acceptable means to protect your Personal Information, like any other service we cannot guarantee its absolute security. All file data transmissions to and within venops.com meet or exceed HIPAA-secure standards of security and encryption.

Links To External Sites

Our Services may contain links to external sites that are not operated by us. If you click on a third-party link, you will be directed to that third-party's site. You are advised to review the Privacy Policy and terms and conditions of every site you visit. We have no control over, and assume no responsibility for the content, privacy policies or practices of any third-party sites, products or services.

Https://www.venops.com/ uses Google AdWords for remarketing. Https://www.venops.com/ uses the remarketing services to advertise on third party websites (including Google) to previous visitors to our site. It could mean that we advertise to previous visitors who haven't completed a task on our site, for example using the contact form to make an enquiry. This could be in the form of an advertisement on the Google search results page, or a site in the Google Display Network. Third-party vendors, including Google, use cookies to serve ads based on someone's past visits. Of course, any data collected will be used in accordance with our own privacy policy and Google's privacy policy.

You can set preferences for how Google advertises to you using the Google Ad Preferences page, and if you want to you can opt out of interest-based advertising entirely by cookie settings or permanently using a browser plugin.

Security and Use of Protected and Personally-Identifying Information

Protected information is shared with Venops expressly for the purposes of regulatory compliance service fulfillment and is at no time shared with any person. The sole exception pertains to using partially identifiable information directly with the HHS Office of the Inspector General or with state offices of the inspector general during certain investigation processes. In every instance, it is the policy of Venops that all protected information is permanently deleted and rendered irretrievable following its use.

Venops, Inc. discloses protected and/or personally-identifying information only to authorized employees that (i) need to know that information in order to process it on Venops, Inc.'s behalf or to provide services available at Venops, Inc.'s website, and (ii) that have agreed not to disclose it to others under penalty of law. By using Venops, Inc.'s website, you consent to the transfer of such information to them. Venops does not share protected information with third parties outside the sole exception defined in the above paragraph. All protected information shared with Venops is done so in a temporary capacity for the active fulfillment of services, with permanent data deletion protocols in place following its use.

Venops, Inc. will not rent or sell personally-identifying information to anyone. Other than to its employees as described above, Venops, Inc. discloses potentially personally-identifying and personally-identifying information only in response to a subpoena, court order or other governmental request, or when Venops, Inc. believes in good faith that disclosure is reasonably necessary to protect the property or rights of Venops, Inc., third parties or the public at large.

If you are a registered user of https://www.venops.com/ and have supplied your email address, Venops, Inc. may occasionally send you an email to tell you about new features, solicit your feedback, or just keep you up to date with what's going on with Venops, Inc. and our products, in addition to specific notification emails related to the services for which you have purchased. Venops, Inc. takes all measures reasonably necessary to protect against the unauthorized access, use, alteration or destruction of protected information and personally-identifying information.

Aggregated Statistics

Venops, Inc. may collect statistics about the behavior of visitors to its website. Venops, Inc. may display this information publicly or provide it to others. However, Venops, Inc. does not disclose your personally-identifying information.

Cookies

To enrich and improve your online experience, Venops, Inc. uses "Cookies", similar technologies and services provided by others to display personalized content, appropriate advertising and store your preferences on your computer.

A cookie is a string of information that a website stores on a visitor's computer, and that the visitor's browser provides to the website each time the visitor returns. Venops, Inc. uses cookies to help Venops, Inc. identify and track visitors, their usage of https://www.venops.com/, and their website access preferences. Venops, Inc. visitors who do not wish to have cookies placed on their computers should set their browsers to refuse cookies before using Venops, Inc.'s websites, with the drawback that certain features of Venops, Inc.'s websites may not function properly without the aid of cookies.

By continuing to navigate our website without changing your cookie settings, you hereby acknowledge and agree to Venops, Inc.'s use of cookies.

Privacy Policy Changes

Although most changes are likely to be minor, Venops, Inc. may amend its Privacy Policy from time to time, and in Venops, Inc.'s sole discretion. Venops, Inc. encourages visitors to frequently check this page for any changes to its Privacy Policy. Your continued use of this site after any change in this Privacy Policy will constitute your acceptance of such change.

Contact Information

If you have any questions about this Privacy Policy, please contact us via or phone or by using the Contact Us link on https://www.venops.com/.

Ecommerce

When you purchase from Venops, you will be asked to provide information including your name, billing address, address of business for which our services apply and/or will be utilized, email address, phone number, credit card/payment details and optional account information like username and password. We’ll use this information for purposes that may include:

  • Send you information about your account and order
  • Respond to your requests including refunds and support
  • Process payments and prevent fraud
  • Set up your account for our store
  • Comply with any legal obligations we have
  • Improve our store offerings
  • Send you marketing messages if you choose to receive them
  • Send you notification messages in the scope of providing services

By using WooCommerce Subscriptions, you may be storing personal data and depending on which third-party payment processors you’re using to take subscription payments, you may be sharing personal data with external sources.

If you create an account, we will store your name, address, email, phone number, and other applicable information requested during registration, which will be used in part to populate the checkout for future orders and to improve services.

We generally store information about you for as long as we need the information for the purposes for which we collect and use it, and we are not legally required to continue to keep it. For example, we will store order information for a minimum of 5 years for tax and accounting purposes. This includes your business name, contact name(s), email address(es), billing address, and business address as it is applicable to the location utilizing our services.

Our staff have access to this information to help fulfill orders, process refunds and support you.

While you visit our site we track the following:

Products you’ve viewed - We’ll use this to show you products you’ve recently viewed;

Location, IP address and browser type - We’ll use this for tax purposes and other analytics related to client location and security; We’ll also use cookies to keep track of cart contents while you’re browsing our site.

Payments

Venops utilizes a third-party payment processor. This payment gateway not only processes payments but also stores the payment information necessary for single and recurring Venops purchases and for refunds where applicable. Financial information is not stored within Venops servers whatsoever. Please see the Stripe Privacy Policy for more details.

Section 2: CMS Open Payments FAQ

Also known as the Sunshine Act, Open Payments is a national disclosure program that promotes a more transparent and accountable health care system by making the financial relationships between applicable manufacturers and group purchasing organizations (GPOs) and health care providers (physicians and teaching hospitals) available to the public.

Physicians, hospitals, life-science manufacturers in general, and group purchasing organizations are applicable for Open Payments. Beginning next year in 2021, payment data for additional provider types will be collected for an inaugural year of reporting set for 2022. More information is available on this topic in the Venops Knowledge Base, accessible by our members.

 

The law requires CMS to collect and display information reported by applicable manufacturers and group purchasing organizations (GPOs) about the payments and other transfers of value these organizations have made to physicians and teaching hospitals. Between the time of data collection and public release, registered physicians and teaching hospitals can review and, if needed, dispute payments reported about them. Data is then displayed on the public Open Payments website.

CMS Open Payments data is published every year to reflect a full 12-month calendar year.  That data is always published in June of the following calendar year. For example, the Open Payments data submitted for the 2018 calendar year was published on June 30, 2019.

All applicable manufacturers (life-science manufacturers in general) and group purchasing organizations have to report any payments or other transfers of value to physicians and to teaching hospitals.

States and CMS have worked closely to ensure compliance with the health insurance accountability and consumer protections in federal law.  The vast majority of states are enforcing the Affordable Care Act health insurance market reforms. Some states lack the authority, the ability to enforce these provisions, or both.  CMS has responsibility for enforcing these requirements in a state that is not enforcing the health insurance market reforms either through a collaborative arrangement with the state or by direct enforcement to ensure all residents of the state receive the protections of the Affordable Care Act.

A civil monetary penalty of not less than $1,000, but not more than $10,000, for each payment or other transfer of value or ownership or investment interest not reported. The total amount of civil monetary penalties will not exceed $150,000.

Knowingly failing to submit payment information will result in a civil monetary penalty of not less than $10,000, but not more than $100,000, for each payment.  The penalty will not exceed $1,000,000.

Combined, penalties may not exceed $1,150,000.

This is another feature of a Venops premium membership. CMS Open Payments reports include expenses and other third-party financial data declared or paid to all physicians under the CMS umbrella.

This is an automated process with no human involvement. The steps are very similar to those of creating our automated exclusion screening reports.

To begin - Venops connects directly with the CMS Open Payments physician profile database to organize and download the data for each report on-demand. Each report takes no more than five minutes to create and return to the initiating client.

For a Venops member the process of creating each report is simple:

  1. Download the template from your Venops dashboard and enter the name(s) for the provider(s) you want to include. 
  2. Securely upload the template from your Venops dashboard.
  3. Your steps for creating this report are done. In minute you will be able to download your report from the Venops dashboard.

Section 3: Exclusion 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:

  1. An encrypted upload from your Venops dashboard provides an "exclusion screening template" with the individuals and entities you want to screen.
  2. Venops accurately crosschecks your list against a direct-source exclusions database of every applicable exclusion/sanction authority.
  3. 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.
  4. 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.
  5. Premium and basic free memberships both include unlimited exclusion screening.
  6. 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.

At Venops we recognize that after you upload your first list of staff, providers, and vendors you may not have any changes from month to month.

In response to this, we created Autopilot™ screening. Autopilot™ will remember every name included on your most recent exclusion report to screen everything through the updated exclusions database every month. This is an automated process that requires nothing from your office to occur.

 

The primary federal government exclusion and sanction authorities utilitze SSN and DOB for objective identification of individuals while the states use other variable information in most cases. Venops uses professional identity verification and background check tools for exclusion screening which require sensitive information. Venops not only identifies possible exclusions – it also verifies or disproves their exclusion status for you. To do that, Venops needs the identifying information used for that particular exclusion/sanction source wherever possible.

Our standards for safeguarding all data are strict. Venops uses industry standard encryption with SOC 2 elements to protect the data shared for exclusion screening and associated clearance investigations.

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.