In addition to the standard identity and criminal record searches that are part of the typical employment background check there are a number of specialized searches that apply to the healthcare industry. As seen in our article, “The Significant Expansion of Exclusion Screening for Health Care Entities under the ACA”, the importance of exclusion screening is increasing. Below are a few of the most popular screening services available to the health care industry.
Office of Inspector General (OIG)
The OIG has the authority to exclude individuals and entities from federally funded health care programs (Medicare, Medicaid) pursuant to sections 1128 and 1156 of the Social Security Act and maintains a list of all currently excluded parties called the List of Excluded Individuals and Entities (LEIE). Anyone who hires an individual or entity on the list may be subject to civil monetary penalties (CMP).
Reasons for exclusion can include convictions for Medicare, Medicaid fraud, patient abuse, felony convictions for other financial misconduct and felony convictions relating to controlled substances. The preceding trigger mandatory exclusions. The OIG may still impose exclusions for similar conduct at a misdemeanor level as well as defaulting on a health education loan.
Reports from this search include an individuals or entities currently excluded from participation in federally funded health care programs. This search is a necessity for any provider rendering services directly or indirectly and payable in whole or in part by a federal health care program.
System for Award Management (SAM) formerly General Services Administration (GSA)
The General Services Administration (GSA) Excluded Parties List System (EPLS) was discontinued in November of 2012. All exclusions were consolidated into what is now known as System for Award Management (SAM) a portal for the Federal Procurement System.
Reports from this search identifies those parties barred from receiving Federal contracts, including healthcare program funding or reimbursement, and from certain types of Federal financial and non-financial assistance and benefits.
FACIS (Fraud and Abuse Control Information System)
Reports from this search include information on disciplinary actions such as debarments, exclusions, probation periods and letters of reprimand. This search has three levels.
This search pulls information from the List of Excluded Individuals and Entities (LEIE) which is maintained by the Office of Inspector General (OIG). It also includes information from what was formerly known as the Federal Excluded Parties List System (EPLS) which was maintained by the General Services Administration (GSA) and is now managed by the System for Award Management (SAM). This search meets the minimum requirements as outlined in the OIG’s Compliance Program Guidance.
This search combines all of the information contained in the Level 1 search and includes sources from one individual state.
This search combines all of the information contained in the Level 1 search and includes a search of the disciplinary action information from multiple agencies as well as those taken by licensing and certification agencies in all 50 states.
The FACIS search is commonly used by pharmaceutical companies, hospitals, home health systems and insurers to determine regulatory compliance, mitigate risk and protect a healthcare provider’s reputation.
An example of how the FACIS search might be used would be a drug manufacturer working with the FDA to prove the safety and effectiveness of a new drug seeking to hire a new clinical investigator. The company would perform a FACIS search on the applicant to make sure he or she had not been sanctioned for submitting false information to the FDA.
Professional License Verification
Providers of certain healthcare services are required to be licensed practitioners. A simple but effective background screening tool for the healthcare industry is the verification of licenses and other credentials. Ensuring that your providers have the proper credentials can mitigate the risk from regulatory audits and private malpractice lawsuits.