Exclusion Screening 101
Exclusion screening occurs at both the federal and state levels. The federal government maintains two principal exclusion databases, the Office of the Inspector General (OIG)’s LEIE database and the System for Award Management (SAM.gov) database. It is important to not become complacent and only conduct screening at the federal level because 43 states also currently maintain their exclusion screening systems that must be complied with.
Federal Level Screening
Under the US Department of Health and Human Services (HHS), OIG maintains a “List of Excluded Individuals and Entities” (LEIE) a vital exclusion screening database for all individuals and entities involved in federal health business.
Specifically, OIG’s LEIE provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid and all other federal health care programs. Individuals and entities who have been reinstated are removed from the LEIE.
OIG LEIE contains:
- The name of the excluded person at the time of the exclusion (make sure to also search the person’s maiden name, possible hyphenated surname, and nicknames)
- The excluded person’s/entity’s provider type
- Verification of the HHS OIG search results using the Employer Identification Number or Social Security Number.
SAM.gov is the other main federal search is at the System for Award Management and is maintained by the General Services Administration (GSA) It evolved from the GSA’s Excluded Parties List System (EPLS), which is now defunct. It also contains the former CCR/FEDREF and ORCA systems.
There is one other federal entity, the National Practitioner Data Bank (NPDB) which also under HHS-HRSA. Part of the NPDB is comprised from the Healthcare Integrity and Protection Databank (HIPDB). However, NPDB does not yet have public search capability and it is often used for orders for self-query. During COVID-19, the NPDB is waiving the query fee for its use. The waiver is retroactive from March 1, 2020, through May 31, 2020. The NPDB will issue query credits to entities that submitted one-time queries, continuous queries, and continuous query renewals between March 1, 2020, and April 14, 2020.
The 43 states currently maintaining their own separate exclusion screening databases are Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky. Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey (Consolidated Debarment and Medical Fraud), New York, North Carolina, North Dakota, Ohio, Oregon Pennsylvania, South Carolina, Tennessee, Texas, Vermont, Washington (HCA & DSHS), Washington, DC, West Virginia, and Wyoming. If one lives or works in any one of them, it is incumbent on them to regularly check your state’s database for updates on the exclusions list.
Some states have specific instructions in respect to their unique laws. Find a list of state databases with Streamline Verify’s OIG exclusions software. Streamline Verify updates its OIG and SAM.gov database every hour, 24 times a day.
Below are highlighted examples from three specific states (Ohio, Texas and New York) which displays some of each state’s specific complexities:
The Ohio law stipulates Medicaid providers are reminded that utilizing their Provider Exclusion and Suspension Lists do not replace “the requirement to complete the following database searches”:
- Ohio Department of Developmental Disabilities Abuser Registry
- Ohio Auditor of State – Finding for Recovery Database
For many years, Streamline Verify provided screening against the Texas Medicaid exclusion list. In Texas, there is a broad, inclusive regulatory scheme includes a strict code of provider exclusion screening requirements enforced by the Texas Health and Human Services Commission, Office of Inspector General (HHSC-OIG).
Within the New York State (NYS)Department of Health, an autonomous entity has been created which draws from eight specific bureaus and offices within the state that make up the Office of the Medicaid Inspector General (OMIG)’s Business Line Teams. New York State also furnishes a webpage that provides an explanation and disclosures regarding their NYS Medicaid Exclusion List. Streamline Verify also highlights New York State’s exclusion screening idiosyncrasies in a separate article.
Streamline Verify OIG Exclusion Screening Software
Screening against these databases may seem tedious, but there are inexpensive and practical ways around it.
Develop an OIG compliance policy and system
To further ensure an excluded individual or entity is not employed, an organization must have a thorough compliance policy and detailed processing in place. Although someone may initially pass a sanction screening, the organization’s policies must guard against future compliance problems. For instance, an organization may have a requirement of potential new hires or providers to have attest to not currently being, or having been, the subject of an investigation before you employ them.
Make sure there are periodic OIG exclusion screenings
It is best practice to conduct a OIG SAM monthly monitoring. The term “periodic” is not specifically defined by regulation or statute. The LEIE and SAM.gov databases are updated each month by the OIG and GSA respectively, so checking less frequently increases the likelihood of an employer inadvertently hiring or retaining an employee, staff or vendor which can expose an employer to avoidable fines, federal contracting problems and HR complications.
This step cannot be emphasized enough – do not be lulled into a false sense of security over someone passing an initial sanction screening. It could be that the employee was going through an investigation at the time of the screening, however had yet to be sanctioned. In this case, no exclusion records would have been made at the time. Non-compliance comes with stiff penalties. Regularly monthly screenings can address this issue for employees, staff, and vendors.
Please refer to this resource for more helpful information on EPLS.