Kusserow on Compliance: OIG continues distancing itself from the GSA debarment list

The HHS Office of Inspector General (OIG) has never called for all health care organizations to screen against the General Services Administration (GSA) System for Award Management (SAM). In the past, the OIG has noted in its various compliance guidance documents that the GSA maintains a federal debarment list and cited it as an additional resource available to health care organizations. The fact that SAM was mentioned by the OIG often leads organizations to believe that they must screen against both the OIG’s List of Excluded Individuals and Entities (LEIE) and SAM.

Yet, for the last several years, the OIG has distanced themselves from the recommendation to health care organizations to screen SAM. In the OIG’s 2013 “Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs” the agency addressed questions regarding its position on screening against SAM and contrasted the LEIE and SAM. The OIG made it clear that it would take action only on parties found on the LEIE and that they had no interest or authority to address confirmed hits on the GSA SAM. It also noted that in January 2011, CMS issued final guidance mandating states to screen all enrolled providers monthly against both the LEIE and SAM, but that was CMS’ position, not the OIG’s position.

This means CMS is the only federal government agency calling for health care providers and plans to screen SAM. The CMS 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 OIG LEIE and the GSA SAM. For health plans, the regulation states that they cannot contract with any individuals or entities that are debarred by 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. It is worthwhile to remember that CMS has not established any enforcement mechanism to deal with providers who have relationships with parties on the SAM debarment list.

As such, distance is growing between OIG and CMS regarding screening against SAM, which has never been user-friendly for health care organizations and yields numerous false matches that then take time and effort in resolve and verify. SAM records simply have very limited identifying information on individuals and entities. GSA designed their system to be used by federal government agencies for procurement purposes, and not for any other purpose or for use by non-federal organizations.

The latest policy statement by the OIG was announced at the recent Health Care Compliance Association (HCCA) Compliance Institute. An OIG Deputy Branch Chief noted that the OIG will soon no longer include screening the SAM as part of compliance integrity agreement (CIA) requirements. The OIG must recognize the added burden on organizations to resolve false hits to SAM. However, the agency made it clear that screening against the LEIE is mandatory, whether or not an entity is under a CIA. So, providers and plans are still confronted with CMS’ position on the subject and continue to struggle with all the problems presented by the user unfriendly SAM system.

Jillian Bower, a compliance screening expert stated that “any provider with a large work force, or that engages many contractors or vendors, finds manual screening too costly, especially when multiple federal and state exclusion lists must be included. Most organizations turn to using a vendor that offers a sanction screening application that can greatly facilitate the process by enabling providers to conduct batch screenings of a large number of names simultaneously against multiple federal and state exclusion lists. However, there remains the problem of resolving potential matches and for many the answer is to simply outsource the entire process to a vendor who will conduct sanction screening against all identified exclusion lists, as well as resolving potential matches.”

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.

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Copyright © 2016 Strategic Management Services, LLC. Published with permission.