Recent Compliance Updates & Tips
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Sanctions Screening Tips to Avoid Violations
As required under CMS’s conditions of participation and enrollment, compliance officers must screen employees against the List of Excluded Individuals and Entities (LEIE). The LEIE continues to expand, with more than 3,000 exclusions added annually. Failure to screen employees, medical staff, contractors, and vendors may result in a greater risk for sanctions. The HHS OIG can consider claims from a sanctioned party to be false and fraudulent, which may result in monetary penalties. Most cases that deal with this issue are brought to the OIG’s attention through the “Self-Disclosure Protocol.” In all recent cases, the OIG’s imposed penalties were mitigated because the matters were self-disclosed. Consequently, none of those cases resulted in a Corporate Integrity Agreement.
The OIG posts many of these cases on its website. The following reflects actions taken in 2017 against organizations that employed individuals they knew or should have known were excluded from participation in the federal health care programs:
- Athena Orchard View, LLC paid $61,576.22 for employing an excluded individual;
- OhioHealth Corporation paid $231,277.60 for employing three excluded individuals;
- Health Sciences, Inc. paid $10,000 for employing two excluded individuals;
- Ridgeview Institute, Inc. paid $29,113.82 for employing an excluded individual; and
- Ocean Dental of Arkansas, PC paid $17,346 for employing an excluded individual.
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Jillian Bower, a compliance consultant for the Compliance Resource Center (CRC), has worked with many organizations to ensure proper sanction screening. The following is a list of her practical sanction screening tips to avoid an actionable violation:
- Ensure periodic sanction screening of employees, medical staff, contractors, and vendors against the LEIE. A best practice is to screen monthly.
- As nearly half of the states have developed their own exclusion database with many mandating monthly screenings, understand and meet state screening requirements.
- Given that most LEIE exclusions arise from an underlying court, state agency, or licensure board action, it is advisable to also conduct background checks and assure that prospective employees, contractors, and vendors have not been subject to any prior court or licensure board actions.
- Encourage individuals, as a condition of employment, staff privileges, or engagement, to attest that they have not been, nor are they now, the subject of any authorized regulatory or enforcement agency investigation; and that they must promptly report any notice of investigation that involves them.
- Educate and inform management and employees of their obligation to promptly report any authorized regulatory or enforcement agency notification of an adverse action.
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