CMS open payments | OIG exclusion list | Monthly OIG screen

Healthcare compliance is complicated. It's almost as if we're trying to solve a giant jigsaw puzzle where the parts are constantly changing. Two of the largest pieces of the puzzle involve staff exclusion screening and financial transparency.   First, let's take a closer look at the concepts of exclusion screening, the lists associated with screening, and the CMS open payment data to determine how they can be explained or defined in simpler terms. The Reality of Exclusion Screening Exclusion Screening is when you check to see if your employees and vendors have been excluded from working in the healthcare field through any of the Federal lists. However, to comply fully with the law, you need to check many more sources of information than just the Federal lists. You can't just check one database to make sure someone is not excluded from working in the healthcare field. You need to check the OIG Exclusions List , SAM.gov (System for Award Management) and numerous state Me...

Compliance with the law is a must for every healthcare provider. The Exclusions List OIG is one of the best compliance tools available. For hospital administrators, doctors, and staffing agencies alike, it is important to know what constitutes OIG exclusion in order to protect your business from large monetary fines and legal repercussions. What Is the OIG Exclusions List? The Exclusions list is also referred to as the List of Excluded Individuals and Entities (LEIE). It is maintained by the U.S. Department of Health and Human Services; it contains the names of individuals as well as entities who have been excluded from participation in federally funded healthcare programs. This includes Open Federal Health Care programs, such as Medicare and Medicaid. An individual or entity may be placed on the OIG exclusion list for a variety of reasons, including fraud or abuse of patients, problems with licenses, or other types of violations that threaten the integrity of federal healthcare prog...

    The healthcare industry has many regulations that require compliance from both the healthcare provider as well as those providing services associated with the provision of healthcare. These regulations require compliance with Federal Privacy Laws as well as accurate billing by submitting the proper code. While the above-mentioned examples represent a significant amount of information, when working in healthcare, the one most important item that needs to be addressed is the exclusions screening process.   Exclusion Screening sounds like complicated legalese, but really it just means you want to ensure that the people that you hire are qualified to work with any federal healthcare programs. Let’s break down what OIG Exclusion is, and why OIG screening is important, and how to use the Exclusion List OIG to protect your company. The Office of Inspector General (OIG), the HHS’ “health police”, investigates and enforces violations of state and federal law in accordance wi...

Bringing new employees into an organization brings plenty of excitement and opportunity for any type of organization but especially one associated with health care. As an organization expands its workforce, you will have the opportunity to serve many more patients or customers than before! However, finding the right employee for your organization is also a big responsibility. Finding the right person isn’t only about verifying educational qualifications and work experience; it’s also about verifying that the person you are considering can legally work in your field. Exclusion screening are one of the ways in which organizations like yours conduct thorough due diligence regarding potential hires; however, they do not require a great deal of technical knowledge to implement and maintain! Exclusion screening are simply a precautionary measure taken by your organization to protect itself, its resources, and its reputation. An exclusion screening is done by going through the list of prohib...

When bringing on a new employee, having a resume, and calling references, is not enough to hire someone in the healthcare industry. Government programs such as Medicare and Medicaid provide the majority of funding for the healthcare industry; this creates many rules for who can work in the industry. When managing a medical practice or healthcare organization, you must protect your business by knowing everything there is to know about compliance and regulations. This includes understanding the Office of Inspector General's role with regard to compliance and financial transparency. To help you understand compliance with the Office of Inspector General (OIG), we provide information about OIG checks, OIG screenings, OIG excluded individuals, and CMS Open Payments. What is an OIG Check? An OIG check is a procedure used to verify if a prospective or current worker is listed on the Office of Inspector General's (OIG) List of Excluded Individuals Entities. The OIG is part of the Depar...

Today, organizations must abide by several regulations that support fair, safe, and trustworthy systems. Organizations also need to understand who they work with, regardless of whether it is a healthcare organization, a business, or a non-profit entity. To ensure this, you have to know about Sanction Checks, the Exclusions List OIG, and being OIG excluded. Although the use of these words might be complicated, the concept behind them is simple. They exist to assist organizations in determining that they are not employing, compensating, or otherwise collaborating with individuals and/or businesses that are prohibited from participating in specific types of programs or services. What Are Sanction Checks? Sanction Checks allow you to verify whether a person or business is listed on any official government or regulatory body’s Sanction List. A government or regulatory body maintains this list to indicate which individuals or organizations are prohibited from certain activities. In the heal...