6 Best Practices for OIG Exclusion Monitoring
Providing a high level of patient safety is paramount to the success of any healthcare organization, and workforce exclusion monitoring is a key vehicle for achieving it.
By implementing reliable tools to help you stay in compliance with workforce monitoring requirements set by the U.S. Office of the Inspector General (OIG), you can manage talent management risks and stay well-informed about your workforce.
Why does OIG exclusion monitoring matter?
Healthcare organizations must protect patient wellbeing and take steps to prevent fraud and abuse. A key action to protect the workplace and patient environment is to avoid hiring individuals who pose a risk to patients, visitors, or other employees.
The U.S. Office of the Inspector General (OIG) helps healthcare employers avoid those risks by requiring certain individuals and organizations to be excluded from healthcare employment. OIG exclusions cover all U.S. healthcare employers receiving funding from programs such as Medicare, Medicaid, TRICARE, and veterans’ programs.
To avoid OIG non-compliance penalties, you need workforce screening processes in place to avoid employing excluded individuals. Around-the-clock, continuous monitoring is particularly beneficial, because it notifies you immediately when an employee has been excluded by the OIG. As a result, you can take action sooner and keep patients, visitors, and other employees protected.
Follow the following six best practices for maintaining compliance with OIG exclusion monitoring requirements.
1. Use the database of record for OIG excluded individuals.
OIG’s List of Excluded Individuals and Entities (LEIE) includes all individuals excluded from working for federally-funded healthcare organizations. Individuals can be added to the LEIE for any of the following actions:
- Patient abuse or neglect
- Medicare or Medicaid fraud conviction
- Healthcare license revocation
- Crimes affiliated with unlawful distribution of controlled substances
- Drug overprescription
- Convictions for healthcare fraud, theft, or misconduct
- Providing unnecessary or unapproved services
The LEIE is updated around the middle of each month and is searchable using online search tools or by downloading the entire list. Because individuals can be removed or reinstated on the LEIE, it’s critical to have a process to check the list for employee names and verify search results with employee social security numbers.
2. Include other applicable lists in your exclusion monitoring activities.
In addition to OIG’s LEIE, there are other exclusion lists and databases you should check to be sure no excluded employee slips through the cracks, including those who may appear on a state-specific list.
Other exclusion lists include:
- U.S. General Services Administration (GSA) System for Award Management (SAM): Lists individuals and firms barred from receiving federal contracts or subcontracts
- U.S. Treasury Office of Foreign Asset Control (OFAC) database: Includes individuals from an embargoed country or region, and those who are prohibited from working or doing business in the U.S.
- State-specific exclusion lists: Examples include Ohio Medicaid, New York Office of the Medicaid Inspector General (OMIG), and California Medi-Cal
3. Understand the risks and penalties for hiring excluded individuals.
Hiring or continuing to employ an excluded individual not only puts patients at risk, but it can also expose your organization to fines and lawsuits. On average, OIG civil monetary penalties can be as high as $130,000. A Texas-based long-term care facility paid a $360,00o fine for employing excluded individuals and billing federal health care programs for services provided by those individuals.
In addition to lawsuits and OIG penalties, your organization can also face reputational damage for employing an excluded person. If an excluded person causes patient or other harm in the workplace, negative headlines would certainly affect your ability to promote your organization as a top healthcare provider.
4. Continuously monitor for exclusions.
The HHS OIG Special Advisory Bulletin recommends consistent monitoring of sanctions lists, making it imperative to check for exclusions even after a person has been hired. Instead of checking the LEIE and other exclusion databases on a quarterly or monthly basis, you can deepen your OIG compliance by checking for healthcare sanctions on a continuous basis.
Continuous monitoring offers up-to-the-minute updates from the LEIE, so you can see employment sanction updates in real time for your employees across different departments and geographies.
Continuous monitoring provides the following specific benefits:
- Tools to help maintain compliance with OIG requirements and guidelines for reducing healthcare fraud set by the Centers for Medicare and Medicaid Services (CMS)
- Full automation of the exclusion monitoring process, which allows your staff to focus on follow-up and corrective action rather than manual monitoring activities
- A shorter time frame between when an exclusion is reported and when you get notified
5. Review your exclusion monitoring activities regularly.
Because workforce exclusion monitoring is critical to the success of your talent management strategy, you should review your screening processes regularly to be sure they are structured to help you meet your goals. In partnership with your background screening provider, conducting regular reviews of your screening program will help you identify new risks and incorporate additional best practices into your program.
Consulting the OIG Work Plan can also help you assess your workforce monitoring program. The Work Plan includes resources, guidelines, and suggested audits to help your organization prevent fraud and abuse in the healthcare work environment. In addition, bringing together internal stakeholders such as compliance, HR, and the chief medical office will support ongoing reviews of your exclusion monitoring practices and help you address a range of potential hiring and talent management risks.
6. Increase compliance and efficiency with a comprehensive continuous monitoring solution.
CS SafeGuard by Corporate Screening is the ideal continuous monitoring tool to help you uncover disciplinary and administrative actions in real-time and stay in compliance with OIG rules for excluded individuals. By replacing monthly or quarterly database uploads which only capture data from one moment in time, our continuous monitoring solution covers your workforce 24/7 and offers the following capabilities:
- Immediate access to employee exclusion data and license updates from OIG, SAM, and state-specific databases
- Tools for roster management and advanced search across all of your employee population groups
- Dashboards to view and report on your workforce by monitoring status, action history, location, and other parameters
- Added layer of protection for all stakeholders by adhering to consumer reporting laws
Improve your background screening capability.
Being a healthcare employer means you have special requirements for hiring and managing your workforce. Background screening doesn’t stop at the hiring process. You also require tools to conduct exclusion monitoring, so you can maintain ongoing compliance with OIG and CMS requirements. Continuous exclusion monitoring is an excellent solution for delivering real-time workforce monitoring, and it offers greater protection for your workplace than a monthly monitoring process.
OIG exclusion monitoring is but one of many compliance considerations affecting your healthcare workforce. You also need to keep your background screening practices compliant with labor laws and Joint Commission guidelines. Use our Healthcare Background Screening Compliance Checklist to assess your screening process and identify potential compliance gaps affecting your workforce.