Kusserow’s Corner: Tips to Mitigate the GSA Sanction Screening Burden

CMS is the only government agency really pushing screening against the Excluded Parties Lists System (EPLS) (now moved to the System for Award Management (SAM)).  The HHS Office of Inspector General (OIG), in its “Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs” of May 8, 2013 made it clear that it does not have interest in cases where a provider finds a debarred party on EPLS and it will take no action ins such cases.

There are no specific regulations requiring providers to screen against the GSA debarment list; however, the Medicare Enrollment Application for Institutional Providers requires applicant hospitals to have a compliance plan that states that the hospitals check all managing employees against the exclusion/debarment lists of both the OIG and the General Services Administration (GSA).  It also requires that a provider not contract with any individuals or entities that are debarred by the GSA as a condition to maintaining active enrollment status. [1]

CMS also requires managed care plans to screen prior to the hiring or contracting of any new employee, temporary employee, volunteer, consultant, governing body member, or First Tier, Downstream or Related Entity (FDR), and on a monthly basis thereafter.[2] Additionally, debarred providers who apply for Medicare shall be denied and debarred providers enrolled with Medicare shall have their Medicare billing privileges revoked.[3]

CMS does not set forth the frequency of sanction screening the GSA debarment list, although it advocates that state Medicaid directors require monthly screening against both the LEIE and EPLS.   It states “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” (42 CFR 424.516).

I don’t believe that CMS gave sufficient thought to what it was requesting.  The fact is that the GSA’s debarment list is intended to prevent the Government from doing business with companies or individuals that demonstrate a lack of present responsibility and is intended for Federal government agencies.[4]  It is not intended for any other purposes.  Debarments prohibit debarred parties from contracting with the government. Health care providers may participate in government finance programs, in that they provide services and products and engage in business activities that are paid for by government programs, such as Medicare or Medicaid, but that does not make them government agencies or grantees of the Federal government. Put simply, those parties who contract with a health care provider are not contracting with the government.

However, the fact remains that CMS calls for health care providers and plans to screen against the GSA debarment list.  It is a burdensome process that produces very little tangible results.  The following are some thoughts about what might be done to mitigate the burden, while meeting what is called for by CMS.

  1. Screen against the GSA SAM only those vendors and contractors providing health care-related services and/or products.
  2. Reduce the frequency of GSA screenings.  Monthly screenings can be excessive in cost, time and effort.  Consideration may be given to screening individuals and parties at time of engagement and annually thereafter.  Alternatively, if GSA screening is something you wish to conduct more frequently than annually, quarterly screening would be preferable and sufficient.
  3. Conduct a “rolling screening” program.  This approach is to have continuous screening of a small portion of the universe of contractors and vendors at a rate whereby all have been checked by the end of the twelve month period.
  4. Outsource the whole screening process in order to save time and costs, as well as gain the confidence that the verification and resolution are accurate and provide peace of mind that you are meeting the sanction screening requirements.
[1]  42 CFR § 424.516(a)(3)(ii)
[2] See the CMS Medicare Managed Care Manual, Chapter 21 – Compliance Program Guidelines, 50.6.8 (last implemented 7/20/12).

[3] See the Medicare Program Integrity Manual (PIM), Chapter 15 – Medicare Enrollment, 15.5.3(B) and (E), 15.8.4, and 15.27.2(a)( last implemented 11/23/12).

See also 42 CFR § 424.530(a)(2)(ii); 42 CFR § 424.535(a)(2)(ii)

[4] David A. Drabkin, Acting Chief Acquisition Officer for the GSA at a House Committee on Oversight and Government Reform hearing on February 26, 2009

Richard P. Kusserow served 11 years as the DHHS Inspector General and currently is CEO of the Compliance Resource Center (CRC), including Sanction Screening Services (S³), which provides sanction screening tools and also provides full outsourcing of sanction screening. For more information, he can be contacted at rkusserow@strategicm.co.

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Copyright © 2013 Strategic Management Services, LLC.  Published with permission.