I have frequently updated on the question of sanction screening in this blog. Questions continue to arise about when and how often individuals and entities engaged by an organization should be screened against the General Services Administration’s (GSA) debarment data. These questions often result from frustration by providers over the user non-friendly data provided by GSA and the difficulty in resolving “false hits.” Added to this is the fact that GSA is continuing to add other databases to the System for Awards Management (SAM), which also includes the Excluded Parties List System (EPLS). I have made clear in a series of articles that I don’t like the idea of screening against the GSA and consider it a waste of time for many reasons, including the fact that the data is designed only for federal government agencies involved in contracting. The following is provided in response to the continuing request for additional clarification on the subject.
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 hospital checks all managing employees against the exclusion/debarment lists of both the HHS Office of the Inspector General (OIG) and the GSA. They also require that a provider not contract with any individuals or entities that are debarred by the GSA as a condition to maintaining active enrollment status. 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. Additionally, debarred providers who apply for Medicare shall be denied, and debarred providers enrolled with Medicare shall have their Medicare billing privileges revoked. CMS does not set forth the frequency of sanction screening the GSA debarment list, although it advocates to state Medicaid directors requiring monthly screening against both the LEIE and EPLS. CMS 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.. It is also worthwhile to remember that CMS has not established any enforcement mechanism to deal with providers have relationships with parties on the debarment list. I don’t believe that CMS gave sufficient thought to what it was doing.
Last year the OIG issued its “Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs,” where it addressed questions regarding the GSA’s EPLS and put a little distance between itself and CMS regarding screening against the EPLS. The OIG noted that in January 2009, CMS issued final regulations mandating states to screen all enrolled providers monthly against both the LEIE and EPLS. The OIG’s position is that LEIE should be considered the primary source for reporting any “hits” to the OIG and that it has no authority to impose CMPs on the employment of a debarred person appearing on the GSA EPLS. In short, the OIG is not interested in GSA debarments and won’t act on any matches to that listing.
The fact is that the GSA’s debarment list is intended to prevent the government from doing business with companies or individuals who demonstrate a lack of present responsibility and is intended for federal government agencies. It is not intended for any other purposes. In fact, the GSA has no interest with any entity that is not a federal agency, and that includes virtually the entire provider and managed care community. Furthermore, the GSA SAM database is not user-friendly. Unlike the OIG LEIE that provides mechanisms for determining validity of hits, GSA does not provide that assistance. As a result, screening against the SAM is a burdensome process that produces very little tangible results.
Bottom line: no agency is prepared to enforce actions involving health care entities engaging anyone who is on the debarment list. However, the fact remains that CMS calls for health care providers and plans to screen against the GSA debarment list. The following are some thoughts about what might be done to mitigate the burden, while meeting what is called for by CMS.
- Screen only those vendors and contractors providing health care-related services and/or products.
- Consider reducing frequency of GSA screenings.
- Conduct a “rolling screening” program whereby there is continuing monthly screening of only a small portion of the universe of contractors and vendors, but at a rate whereby all have been checked by the end of the 12-month period.
- 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 providing peace of mind that you are meeting the sanction screening requirements.
Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.
Copyright © 2014 Strategic Management Services, LLC. Published with permission.