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Recent Compliance Updates & Tips

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Over the last decade, there has been a strong trend to outsource as many non-core business functions as possible. This is done to save staff, time, and costs, as well as expand access to better expertise. Compliance programs have seen many trends, most notably in outsourcing the hotline, training, and employee compliance surveys, among others. Recently, the most rapid movement has been to address the quickly growing cost and time obligations related to sanction screening. The commitment to sanction screening began with HHS OIG introducing its “List of Excluded Individuals and Entities” (LEIE), and calling for the screening of employees, physicians, vendors, and contractors against it. Failure to screen excluded individuals or entities could result in all claims and costs associated with that party being viewed as false and fraudulent, resulting in significant financial penalties.

CMS has gone further, making sanction screening a condition of participation or enrollment requirement. Federal regulations now state: “To obtain/maintain active enrollment status, providers may not employ or contract with individuals/entities excluded from participation in any federal health care program or debarred by the GSA from any other executive branch program or activity.” Because of this, sanction screening obligations have been extended to the GSA debarment database known as the Excluded Parties List System (EPLS), which is now a part of the System for Awards Management (SAM). Additionally, CMS has sent letters to the State Medicaid Directors calling on them to establish Medicaid sanction databases and requiring their enrolled providers to screen their employees and contractors against it on a monthly basis. This is in addition to monthly screenings against the LEIE. Most states have already moved to establish their own Medicaid sanction lists, and many now mandate monthly screening. Over the years, additional federal sanction databases have been identified as useful for screening, including those databases maintained by the Drug Enforcement Administration (DEA) and Food and Drug Administration (FDA). All of this has increased the sanction screening burden exponentially, not only for the Compliance Offices, but also for Human Resources in screening new hires and periodically screening current employees. The number of vendors and contractors that have to be screened affects procurement, because this number is a multiple of the other parties that need to be screened. Medical credentialing is also involved, as physicians granted staff privileges must be screened as well.

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Today, it is common for organizations to use vendor search engine tools to assist in sanction screening. This saves entities from having to download all of the sanction databases and developing their own search engines. However, the bulk of the work remains with the organization to perform screening and resolve potential “hits.” This is a considerable undertaking, and many organizations must dedicate one or many employees to meet all these obligations. For those that manage the entire sanction screening process in-house, consideration should be given to using a vendor sanction screening search engine service.

Tips in Selecting Sanction-Screening Vendors

  1. Only use services on a fixed rate, not services that charge per-click or based on the volume of screening. The latter can run up the costs to a prohibitive level.
  2. Ensure the contract permits cancellation without cause at any time. Vendors should be kept as result of good service, not by contract terms.
  3. Determine if vendors provide any other services or support in addition to using their tool, such as policy templates, regulatory updates, advisory notifications, etc.
  4. Inquire about what filters, algorithms, or logic tools the vendor uses to identify parties with incomplete or altered information.

Tips in Outsourcing the Entire Function

The next logical step in outsourcing is to have a vendor perform the screening for you, including resolution of the potential “hits.” Consider the following in exploring this option:

  1. Determine the cost. It may not be much more than the cost of using vendor search engine tools.
  2. Inquire as to the methodology they follow in resolving potential “hits,” a critical part of any screening effort.
  3. Ensure the vendor will provide a certified report of the results that can be made part of Compliance Office records.
  4. Review an example of the type of reports the vendor would provide to determine if it meets the documentary needs of the organization.
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