Jeannine LeCompte, Publishing and Research Coordinator
The Office of Inspector General (OIG) will impose civil money penalties against providers that employ or contract with excluded persons to provide items or services for which payment may be made by federal healthcare programs, such as Medicare or Medicaid. The OIG can hold providers responsible if bills include items or services that were provided by an employee or contractor who is excluded from participation.
Skilled nursing facility (SNF) administration must provide oversight of the employee screening process. They need to ensure that the screening is conducted according to written policy; that all employees, physicians, vendors, and other agents are being screened; and that there are policies and procedures for proper documentation. There should also be a process in place to address any negative results.
Auditing and monitoring should be conducted to ensure all requirements are being done according to policy:
- Document review to ensure employee disclosure requirements are clear in the policy
- Policy review to ensure that immediate reporting is a requirement for all affected
- Employee files contain documentation which supports that employee screening took place prior to hire and that compliance education is taking place
- A review of all types of screenings and any other names/states used by employees
- Policies which are in place for negative results
- Documentation of employee interviews confirming the importance of current licensure and providing clear employment requirements
- Job descriptions, training/orientation materials, and annual performance evaluations
- Confirmation that the exclusion screening process has been communicated to all personnel
- Exclusion checks from OIG and State lists
- License and certification verification (are they current)
- National Practitioner Data Bank verification for physicians
- Employee and vendor attestations are on file and current for:
- Code of Conduct
- Conflict of Interest
- Anti-Kickback Statute
- DRA – Deficit Reduction Act
- Business Associate Agreements are signed/on file
There should also be verification that background checks are conducted in accordance with rules and regulations, due diligence is being conducted on third parties, and government sanction lists are being monitored regularly for excluded individuals. Corrective action should be taken based on background findings.
Good compliance management means being familiar with and complying with laws, rules, regulations, and company policies, including the code of conduct.
