Healthcare Sanction Checks: An Important Part of Your Background Screening

Your healthcare workforce is in the trusted position of caring for the ill and injured. But trust can quickly fade if an employee performs work in violation of a healthcare sanction or employment exclusion. In addition to the risks it poses to patients, hiring someone who has been barred from working in healthcare can result in fines and the withdrawal of federal funding. It can also put your accreditation in jeopardy.

There are several regulations in place to protect your organization from employing “bad actors”—individuals whose past actions pose a risk to patients and healthcare programming. All healthcare organizations must comply with guidelines for national background checks established by the Centers for Medicare and Medicaid Services (CMS). In 2019, CMS announced a new rule aimed at preventing hospitals and health systems from affiliating with individuals and entities convicted or suspected of committing fraud. Another regulating agency, the Office of Inspector General (OIG), can impose healthcare employment exclusions under the authority of the Social Security Act, and it enforces sizable civil monetary penalties for violations.

You can’t control the actions of candidates and employees, but you can be informed when those actions impact your workplace. When your healthcare background screening program includes thorough sanction checks, you can avoid the penalties of hiring excluded individuals and have a more compliant hiring process.

Benefits of Healthcare Sanction Checks

A recent Johns Hopkins study found that patients treated by providers excluded from certain healthcare employment were more likely to be poor and disabled. By keeping excluded individuals out of your workplace, you don’t just avoid penalties and a potential loss of reputation, but you also protect the most vulnerable of patients.

Some of the benefits of comprehensive healthcare sanction checks include:

• Improved patient safety: By identifying sanctioned individuals and those with histories suggesting a safety risk to patients, you can reduce the chances of malpractice and patient abuse.
• Better compliance: When your screening activities comply with federal and state law, you protect the organization from losing accreditation or the ability to participate in federal and state health programs.
• Lower risk of fines and lawsuits: A robust sanction check program developed in accordance with federal laws protects you from monetary fines and individual or class-action lawsuits.
   

Where to Check for Healthcare Sanctions

Healthcare sanction lists help you identify individuals who have committed acts that put their medical licensing at risk and exclude them from healthcare employment. Pre-hire and continuous sanction screening flags actions such as:

• Patient abuse or neglect
• Healthcare license revocation
• Crimes affiliated with controlled substances
• Drug overprescription
• Healthcare fraud
• Medical probations and reprimands

Sanction checks include searching federal databases, as well as state-specific registries and global lists. Databases and lists are updated regularly, so you’ll need to have a process for ongoing sanction monitoring. 

You should include the following lists and databases when conducting healthcare sanction checks:

• U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) List of Excluded Individuals and Entities (LEIE): Lists individuals excluded from working for healthcare organizations that receive federal funding 
• U.S. General Services Administration (GSA) System for Award Management (SAM): Lists individuals and firms barred from receiving federal contracts or subcontracts
• Healthcare Fraud and Abuse Lists: Provide individual sanction histories using data from federal agencies and over 800 licensing and certification agencies across 50 states
• National Practitioner Data Bank (NPDB): Contains reports on medical malpractice payments and other adverse actions taken against health care practitioners and suppliers
• Global Sanctions and Watch List: Includes individuals named as national security threats by the Patriot Act
• State-Specific Exclusion Lists: Provide information about individuals barred from healthcare employment in specific states
   

Best Practices for Healthcare Sanction Checks 

During the hiring process, you want to be sure the individuals you hire possess the qualifications to work in your organization. Checking for healthcare sanctions as part of an employment background check surfaces any past actions that pose a hiring risk. However, staying on top of sanction checks extends beyond a one-time search during the hiring process. To conduct background screening that keeps your workplace protected, you’ll need ongoing reviews and monitoring.

A periodic background screening audit can help you determine which employee job categories require sanction checks and where your program may have compliance gaps as a result of changes in federal or state legislation. Regular audits of your healthcare screening program can help you answer the following questions:

• Do sanction screening activities adhere to applicable federal laws? 
• Do our screening activities comply with laws in the states where we operate?
• Are our disclosure and authorization forms current and do they cover healthcare sanction checks?
• Does our existing adverse action process help employees understand how information obtained during a sanction check can adversely impact their employment?

Another important best practice for healthcare sanction checks is continuous monitoring. Instead of merely checking exclusion lists on a quarterly or monthly basis, you can check for healthcare sanctions continuously. Continuous exclusion monitoring helps you protect your workforce and your patients throughout the year, and it also helps you satisfy OIG requirements to monitor sanction lists consistently. 

There can often be a time lag between when an individual commits an act leading to sanction by a licensing board or other authority, and when they appear on an exclusion list. Continuous sanction screening notifies you immediately when any action is reported affecting an individual’s license or exclusion status, so you can always be informed of new developments impacting your workforce. When you use next-gen continuous monitoring technology, you can eliminate manual sanction searches and view sanction updates for employees across different departments and geographies.

Remain Compliant with Ongoing Healthcare Sanction Monitoring

Since healthcare regulations are always changing and, in most cases, expanding, compliance will remain an essential part of maintaining a healthy background screening program. Healthcare sanction checks keep you in compliance when you hire and as you continue to manage the workforce. 

Keeping step with changing laws and exclusion lists affecting who can be a part of your workforce is no small task, but you can find success with a trusted background screening provider to guide you. A background screening partner that offers continuous exclusion monitoring and regular compliance guidance can help you protect patients and maintain an efficient healthcare background screening program.