Kusserow on Compliance: Meeting sanction-screening requirements

As the HHS Inspector General, I created what is now referred to as the List of Excluded Individuals and Entities (LEIE). This was followed by various HHS Office of Inspector General (OIG) compliance guidance documents that call for screening employees, physicians, vendors, and contractors against the LEIE. Subsequently, the OIG encouraged screening against the General Service Administration’s (GSA) Excluded Parties List System (EPLS), now part of the System for Award Management (SAM).  Other federal sanction databases worth screening are maintained by the Drug Enforcement Administration (DEA) and FDA, as well as the Department of the Treasury Office of Foreign Assets Control (OFAC) Terrorist Watch List. As a condition of enrollment, providers may not employ or contract with individuals or entities that are excluded from participation in any federal health care program.  All claims and costs associated with an excluded party may be viewed as false and fraudulent and, potentially, leading to significant financial penalties and more.  The OIG Special Advisory Bulleting on the Effect of Exclusion provides very useful information in assessing this risk area

CMS calls for screening, not only against the LEIE, but also the GSA debarment list. It sent letters to State Medicaid Directors calling on them to screen their enrolled providers for exclusions against state Medicaid exclusion databases on a monthly basis. To date, 40 states have moved to establish their own Medicaid sanction lists, with a number of other states in the process of doing the same. This has increased the sanction screening burden exponentially, not only for the compliance office but other departments as well. Human resources management (HRM) normally has the responsibility of screening new hires and periodically screening current employees.  Procurement is also affected because it handles the screening of vendors and contractors.  Lastly, the Medical Credentialing Office must be involved in order to screen physicians who have been granted staff privileges.

Alena Treen, of the Compliance Resource Center (CRC), has more than 15 years’ experience with sanction screening services. She notes that spending time, money, and resources on developing and maintaining a search engine and regularly collecting and updating sanction information from many databases is not very cost effective. This all has to be done before you begin the search process and resolving potential hits.  This option is prohibitive in terms of costs, time, effort, and quality control to guard against errors or omissions.

Carrie Kusserow also has over 15 years’ experience in sanction screening as a compliance officer and consultant. She makes the point that the high cost of using internal resources to develop and manage the sanction-screening process has resulted in the great majority of health care entities subscribing to a vendor service that provides a search engine to their established databases. Vendors can afford the high cost of maintaining the currency of the data because they amortize the costs over many clients. The problem is that vendor quality, cost, and reliability can vary enormously. From experience, she offers the following tips for those considering a vendor:

  1. Know the cost up front with a fixed rate, not based upon per click searches.
  2. The contract should permit cancelling, without cause at any time, if dissatisfied.
  3. Ensure the vendor has liability insurance (preferably $1-3 million).
  4. Determine other services included (e.g. policy templates, regulatory updates, etc.).
  5. Determine how much “help desk” assistance is available to resolve potential hits.

Outsourcing sanction screening process

Jillian Bower has been providing sanction-screening services for years. She says using a vendor’s sanction screening tool to conduct screenings is only part of easing the burden.  The bulk of the effort remains in conducting the actual screening, resolving potential “hits,” and preparing a report for the record to evidence it was all done correctly.  In seeking the right vendor, look for one that includes all those steps in its agreements, but also permits–without added charge–the use of the vendor’s tool for ad hoc and individual screening, as needed.  The vendor also should be prepared to provide certified reports on the results of each round of screening that can be made part of the organization’s permanent record to evidence its completion; it should be available if the OIG or another government agency challenges the organization on meeting this compliance obligation.  Bower says the additional cost of going beyond just using a vendor’s sanction screening tool to having the vendor actually perform the searching and resolve the potential hit is surprisingly inexpensive, when compared against the time and cost of doing the work in-house.  In many cases, it may be actually be less than what some vendors would charge for only using their screening tools.  She stresses the importance of maintaining records of all sanction screenings to evidence that it was conducted properly to avoid penalties.

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 © 2017 Strategic Management Services, LLC. Published with permission.