The process of verifying whether the individual or entity is excluded or prohibited from participating in federally funded healthcare programs is known as OIG screening. The reasons for exclusion include patient abuse, illegal selling of controlled substances, federal fraud, or other fraud. Being on the OIG exclusion list indicates that the individual or the entity(e.g., Vendor or Service Provider) is unsafe to work with. In the worst case, the organization may face financial and reputational damage by working with such excluded parties. Performing continuous and accurate exclusions screening is an effective solution to avoid such risks.
Further in the article, we will discuss important and frequently asked questions about OIG exclusions screening and background checks.
What are OIG Checks, and why are they essential for Healthcare Providers?
The healthcare provider performs an OIG check or OIG background check to prevent hiring or working with excluded individuals/entities. Organizations either use their workforce to perform these checks or hire a trusted third-party compliance support service. Generally, healthcare providers prefer the latter option as it helps them save their precious working hours.
These checks are highly essential for healthcare providers in the following ways:
- It saves the organization from working with excluded individuals and vendors. Those who are excluded by OIG are involved in illegal activities or have a criminal background. Working with such individuals and vendors exposes your organization to financial fraud and can significantly decrease the quality of your services. This, in turn, leads to bad reviews by the patients. However, you can avoid all these risks with continuous and accurate OIG background checks.
- The more significant advantage of these checks is that they save your organization from severe civil monetary penalties and fines. This is all related to working with excluded individuals and vendors. Suppose your organization hires or works with an excluded individual, or enters into a contract with an excluded vendor or services provider. In that case, you will face severe monetary penalties and fines. That is precisely why screening your new hires, current staff, potential vendors, and current vendors is crucial. It helps you to avoid these fines and penalties.
- For healthcare providers, building a reputation and trust among patients is essential and takes a lot of time and effort. People take their time before trusting others with their health and well-being. Providing quality services and staff behaviour play an important role in this. OIG screening helps you filter out bad or unprofessional individuals and vendors. As a result, it helps your organization hire well-qualified and trained professionals. This helps to improve the services provided by the organization and build trust among the patients.
What is the significance of Continuous OIG Screening?
One of the main reasons why organizations hire a compliance support service is that screening processes are not a one-time thing. Whether it is sanctions checks, compliance screening, or OIG screening, it needs to be done regularly to ensure accurate results. The need for continuous screening arises because the list of excluded individuals/entities(LEIE) updates regularly. It is possible that the individual or the vendor may be present on the updated list who was not excluded last month. Therefore, to ensure that your staff and vendors are screened against the latest exclusion list OIG, continuous background checks are necessary. Officials suggest performing OIG screening and background checks every month.
Is OIG screening enough to ensure legal compliance?
While OIG sanction screening is crucial in investigating the background and legal condition of staff(current or new) and vendors(current or new), it is not the complete solution. OIG screening is itself a part of Sanction checks, which include checking against other lists and checks, like SAM, FACIS, and OFAC. In addition to these checks, a complete vendor screening process also helps perform thorough background checks on current and potential vendors. Therefore, screening processes take a significant amount of your working hours. Also, you need industrial experience and expertise to perform these checks quickly and accurately.
Why does OIG exclude individuals/entities?
OIG, or the Office of Inspector General, maintains a list of excluded individuals/entities, also known as LEIE. They have the authority to add individuals and entities to this list. But on what basis can they do that? According to the Official OIG website, the reasons for OIG exclusion include:
- Medicare or Medicaid fraud, or any other fraud associated with items or services that come under Medicare, Medicaid, or other state-funded healthcare programs.
- Ignoring patients and professional duty, or being involved in patient abuse
- Found guilty of other healthcare-related program fraud or other financial misconduct
- Illegal handling of controlled substances, including unlawful manufacturing, prescribing, distributing, or dispensing
- Suspension of the license because they were unable to perform their professional duties, or were not professionally qualified or competent
These are some of the main reasons for exclusion. However, there can be other reasons for exclusion that are not in the list above.
What are the effects of the OIG Exclusion?
The immediate effect of exclusion is that the individual or the entity(vendors or service providers) will stop receiving any kind of financial aid, including Medicare and Medicaid. This also includes other federal plans that provide health benefits and are directly or indirectly funded by the United States. In case the excluded individual or entity is found claiming federally funded items or services, they can be charged with a fine of $10,000 per item or service.
Along with the excluded individuals/entities, OIG exclusion can significantly affect the healthcare provider who hires or works with them. Working with excluded people or contracting with an excluded vendor subjects you to severe civil monetary penalties and other fines. That is why officials recommend performing exclusion screening of potential hires, vendors, and service providers.
Why choose Venops for OIG exclusion checks and Sanctions Screening?
As we have discussed above, what is OIG screening, and why is it significant for healthcare providers. Now, let’s understand why you need an experienced compliance support service for OIG exclusion and sanction screening. Having an experienced screening partner can save precious working hours, provide you with quick and accurate results, and help you avoid financial loss. Venops is a trusted compliance support service that provides all these benefits at the right price. With our automated tools, we offer automated monthly screening. This helps to verify the status of current and new hires or vendors.
We always ensure the screenings are done against the latest and updated databases. With Venops, you get vendor screening for your organization without any additional cost. There is no need to ask for a quote as we have transparent pricing. All you need to do is register for free to access the price calculator. For any doubts or further queries, you can contact our customer support staff.
