Exclusion screening protects healthcare organizations from working with parties that are not fit to work with. They may have a criminal history or be involved in federal or Medicaid fraud. Working with or associating with such individuals or entities puts healthcare organizations at high risk of financial and reputational losses. Exclusion screening helps protect you from these risks by verifying the qualifications of potential hires and vendors throughout the process. As a result, underqualified individuals and service providers are filtered out, enabling you to work with parties with a clean background.
Additionally, performing the screening process helps you update your database and verify whether any existing employee, vendor, or staff member is not on the exclusion list OIG. While there are multiple benefits to the screening process, it is crucial to perform it accurately. However, accurate screening requires time and is a data-driven process. In this blog, we will offer you some essential tips to perform the screening process effectively and avoid unnecessary time and money.
Essential Tips for Performing OIG Exclusion Screening Effectively
The following list contains some crucial tips that you can use to perform the exclusion screening process with higher accuracy, ensuring effective results:
1. Go Through the Necessary Compliance Requirements
Before performing the screening process, understand the compliance requirements. The healthcare industry is one of the few sectors subject to strict compliance regulations. Whether it is the educational, financial, or criminal background, you are required to perform thorough checks on multiple levels. Therefore, understanding the compliance requirements will help you perform the screening process better.
2. Use the Latest and Recently Updated OIG Database
OIG is an independent organization that works under the government and has the authority to maintain the LEIE (List of Excluded Individuals/Entities). And they update their database and list of excluded parties. Therefore, it is possible that parties that were not on the list previously may be present in the latest list. Hence, not using the latest database or list can lead to inaccuracies in OIG screening or other screening processes.
3. Try to Automate the Process
A significant way to increase the speed of the screening process is to use automated software. It has been proven that automated software tools for screening not only significantly increase screening speed but also ensure highly accurate results. This is not possible manually and is more prone to errors.
4. Keep Everything Documented
Whether you find excluded parties during the screening process or not, document everything. Each detail of the screening process should be documented in writing. This will support your audit and compliance checks and help you prove your credibility. Documentation also helps ease the screening process in the future, allowing for monitoring of predictable results.
5. Perform the Exclusion Screening on Multiple Government Databases
OIG screening is one of the most popular and critical processes for healthcare organizations. It helps you learn about the parties (individuals and entities) who are excluded from participating in federally funded healthcare programs. However, there are other crucial lists for the screening process. Here are details about other sanctions lists:
- System for Award Management (SAM) – Lists debarred entities that cannot receive federal contracts or payments, including healthcare services.
- GSA Excluded Parties List – Prevents federal agencies from doing business with excluded or suspended parties.
- State Medicaid Exclusion Lists – Identifies providers barred from state Medicaid programs due to fraud or noncompliance.
- HHS/OIG Civil Monetary Penalties (CMP) List – Tracks entities and individuals penalized under federal healthcare laws.
6. Understand the Risks of Non-Compliance
You should be aware of the risks associated with non-compliance with the exclusion screening and background verification. You can lose reputation by being associated with criminals and parties involved with financial fraud. The absence of screening can significantly reduce the quality of services offered by the healthcare organization. Moreover, hiring or working with excluded parties makes you liable to pay financial fines and severe Civil Monetary Penalties. The amount of fines and penalties depends on the case’s severity.
7. Hire a Trusted Compliance Service Provider
Performing the screening process yourself can be challenging and may require dedicating a substantial amount of your workforce and their working hours. Instead, you can hire a trusted compliance service partner to perform the exclusion screening for your organization. While it may seem like an additional expense at first, it has long-term financial benefits. Saving you from potential re-screening and ensuring complete accuracy in the screening process.
How Venops Ensures a Completely Accurate Exclusion Screening Process?
At Venops, we offer a complete screening solution for healthcare organizations, saving them from working with potentially risky parties. With our experience in compliance services, you can rest assured that you will receive accurate results. And a significant advantage is that it will not affect your core operations. You can focus on performing the healthcare services, while our experts will handle the complexities of the exclusion screening.
We use exclusive software tools to perform daily or monthly screening with automated workflows. And the results? A quicker screening process that offers accurate results. As a trusted, reliable compliance partner, we also offer vendor screening services to our clients at no additional cost. Consequently, we offer you complete compliance solutions.
Contact us to get accurate exclusion screening services and improve your healthcare service quality!
FAQs
Q.1: What do you mean by healthcare exclusion?
A: Healthcare exclusions are referred to individuals and parties that are prohibited from participating in federal healthcare programs. The exclusion grounds are serious, which is why working with excluded parties subjects healthcare organizations to financial penalties and CMPs. There are many other risks involved with excluded parties that can harm the healthcare organization’s reputation.
Q.2: Which healthcare staff members can be on the OIG exclusion list?
A: The following list contains the staff members who OIG or other organizations can exclude:
- Physicians and Surgeons – due to fraud, abuse, or disciplinary actions.
- Nurses (RN, LPN, NP) – for misconduct, fraud, or regulatory violations.
- Pharmacists – for controlled substance violations or billing fraud.
- Therapists (PT, OT, Speech) – for improper billing or ethical violations.
- Dentists and Dental Hygienists – for fraud or Medicaid/Medicare violations.
- Medical Technicians / Lab Staff – for falsifying results or regulatory noncompliance.
- Administrators / Billing Staff – involved in fraudulent claims or program abuse.
- Contractors and Vendors – providing services or products linked to fraud or misconduct.
Q.3: How can I simplify the Exclusion Screening process?
A: You can simplify the exclusion process by choosing the right service provider, such as Venops. With our experience and technical expertise, we will help you avoid penalties and ensure you receive accurate screening services.
