SAM Replaces EPLS: How to Make Sure You Are Compliant

Unbeknownst to many in the health care compliance industry, the General Services Administration (GSA) announced it was migrating data from the well known Excluded Parties List System (EPLS) to a new and more comprehensive system call the System for Award Management (SAM).  Implementation of this new system yields a more streamline federal government contracting process. However, those outside the federal contracting process received little notice that the EPLS, used by most managed care organizations to screen for excluded individuals and entities, has now become obsolete. A lack of adequate notification has left many organizations scrambling to figure out how to access the exclusion list in order to maintain compliance with government guidance.

The EPLS was a separately maintained list that included individuals and entities debarred or suspended from doing business with the federal government, collectively referred to as excluded parties. Government agencies screened the EPLS as a component of the procurement process of new vendors to ensure the individual or entity was not excluded from federal contracting participation. Questions have been raised whether health care organizations, non-government agencies, should screen EPLS.  While managed care organizations do participate in government financed programs, such as Medicare and Medicaid, it does not make them a government agency. Furthermore, those parties that contract with a managed care organization are not contracting with the government.

Health care related exclusions are the responsibility of the OIG. Any exclusion imposed by the OIG is posted to their List of Excluded Individuals and Entities (LEIE) and also on the EPLS. The OIG has only encouraged screening against the GSA database.  In light of the EPLS migration to SAM, OIG actions will now also appear on the exclusion list included in SAM.  CMS has gone further and states they take into consideration whether an individual or entity is debarred and appeared on the EPLS, now SAM, as a condition of enrollment and maintaining active status.

Although the Department of Health and Human Services (DHHS) Office of Inspector General (OIG) does not mandate screening against the GSA debarment list, the OIG does encourage screening as part of an effective compliance program. Pursuant to the DHHS OIG’s compliance guidance, managed care organizations should check whether an employee or contractor is excluded at the time of hire and periodically thereafter. The guidance specifically highlights screening excluded and debarred individual and entities included on the lists maintained by the OIG and the GSA. Since the release of SAM, the OIG has not come out with a separate guidance document regarding the new system.

However, the Center for Medicaid and CHIP Services at the Centers for Medicare & Medicaid Services issued an Informational Bulletin on August 1, 2012 notifying the state Medicaid directors that EPLS migrated to SAM. The letter reminds state Medicaid agencies to advise their providers to conduct regular sanction screenings (monthly) against both the OIG and GSA lists. Inasmuch as a sanctioned provider may not submit claims for payment from Medicare or Medicaid, providers who don’t screen against the federal sanction databases run the risk that claims may not only denied but considered false and fraudulent.

EPLS vs. SAM

Because SAM consolidates the procurement process from a federal government perspective, the new system incorporates several databases typically consulted during that process. Currently, SAM incorporates the Central Contractor Registration / Federal Agency Registration (CCR / FedReg), Online Representations and Certifications Application (ORCA), and the EPLS into one online web site.  Future phases of SAM will include additional databases screened during the procurement process. However, for the purpose of sanction and exclusion screening, health care providers simply need to check the exclusion data, former known as the EPLS.

The purpose of the SAM exclusion list is no different from the EPLS, which is to provide a list of individuals and entities debarred from contracting with the federal government. However, managed care organizations should be aware of several changes related to how to search the data and what details are included on the SAM exclusion list.

Since SAM incorporates information from CCR / FedReg and ORCA the results of a search must be filtered to display only exclusion records. This filter is helpful to eliminate records that are not necessary to review. It is important to also note the following changes:

• Search Options. EPLS included an Advance Search, Multiple Name Search and Exact Name and Social Security / Tax Identification Number Search.  SAM allows for only a single name search. However, as you begin typing in the name it auto displays possible name matches. Additionally, a wild card (i.e., * or?) can be used to yield fuzzy matches.

• New Party Type. EPLS included three party types, Firm, Individual, and Vessel. Special Entity Designation is a new type of classification and is considered a miscellaneous party type.

• Cause and Treatment Codes. Going forward exclusion records will not include a cause and treatment (CT) code, which indicates the reason why the entity has been debarred. CT codes will still display for all exclusion records prior to the migration. Going forward, the CT codes have been mapped to four exclusion types: Ineligible (Proceedings Pending), Ineligible (Proceedings Complete), Prohibition/Restriction and Voluntary Exclusion.

It is equally important to note functionality that remains after the migration and that is especially important in efforts to conduct sanction and exclusion screenings.

• Social Security Number Verification. Although SAM does not allow for searching the exclusion list using the social security number (SSN) the results of a name search can be filtered using the SSN. SSN verification is important in verifying a match, particularly in SAM, since the date of birth is unavailable.

• Address Verification. After identifying a possible record match, the street address can be verified. Similar to EPLS, SAM only publically displays the city, state and zip code.

• Excluding Agency. The federal agency that imposed the exclusion is indicated in the record. The excluding agency is helpful in determining whether HHS or another agency excluded the party.

It is important that managed care organization familiarize themselves with the SAM exclusion list in order to maintain compliance with government guidance. As part of an effective compliance program outlined by the OIG, managed care organizations should implement policies and procedures that effectively state it prohibits the hiring of excluded individuals and describes how the organization conducts necessary screenings to prevent hiring of such individuals. In light of these changes to search capabilities with SAM, managed care organizations should consider updating sanction and debarment screening policies and procedures.

Although it will take time to become familiar with the nuances of using SAM, what you will find is that the screening results historically received when screening EPLS will be similar to the results retrieved when screening the SAM exclusion list.

Editor’s note: Jillian Bower is   Vice President of Business Development and Marketing for the Compliance Resource Center (CRC), a comprehensive and integrated end-to-end compliance management tools that includes sanction screening services. She may be reached at 703/535-1405 or at [email protected].