Exclusion & Sanction Screening FAQ

Yes it is. Verifying the clearance of business associations with excluded parties is a required regulatory compliance item. Enforcement is overseen and carried out by HHS OIG.

As explained by HHS, “OIG has the authority to exclude individuals and entities from Federally funded health care programs pursuant to section 1128 of the Social Security Act (Act) (and from Medicare and State health care programs under section 1156 of the Act) and maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals/Entities (LEIE).”

Monthly and pre-hire screening aligns with best practices and follows the latest recommendations by HHS OIG. It is the industry standard. This frequency also supports updates to the LEIE and other exclusion/sanction authorities that occur monthly (or more often).

As a Medicare, Medicaid, or Tricare provider – applicable payees including physicians, employees, and even vendors must be crosschecked against the OIG List of Excluded Individuals and Entities. Billing under these programs while associated with excluded parties can result in compounded civil monetary penalties.

Early on, Venops adopted a comprehensive approach to track all applicable exclusion and sanction authorities in addition to the List of Excluded Individuals and Entities (LEIE). Since then, it has become the industry standard. Why? The need for monthly screening arises not only from staffing changes, but also from the dynamic nature of the exclusion and sanction authorities themselves. Many of them change monthly – some weekly – and those authorities are monitored by Venops.

Providers and contracting entities have an affirmative responsibility to routinely verify the exclusion status of individuals and entities and maintain a record.

Violations and Civil Monetary Penalty (CMP) amounts of the OIG LEIE fall under the False Claims Act (FCA). 

Details of CMP assessment include:

• Fines for each item or service furnished by the excluded individual or entity.
• An assessment of up to three times the amount claimed (the amount paid to the health care organization by the government program going back as many as 6 years).
• Government Funded Program exclusion

CMPs are codified and adjusted for inflation annually (typically in November). The latest adjustments can be referenced at 45 CFR § 102.3 as well as 45 CFR § 1003.210.

Venops mitigates compliance risk with automated exclusion screening through all applicable exclusion and sanction lists.

There are multiple exclusion and sanction lists tracked by Venops. While the federal OIG LEIE and GSA SAM are the most recognized exclusion lists, the majority of states have additional exclusion lists that should be tracked every month. Additional exclusion and sanction authorities are also included with Venops screening, such as the lists for OFAC, Tricare, and CMS Opt Out affidavits. A full list of exclusion authorities tracked by Venops can be found in the Help Desk.

The exclusion & sanction screening process is straightforward:

1. A formatted roster is securely uploaded from your Venops dashboard with the individuals and affiliated entities you want to screen. HRIS connectivity is available, such as through ADP.
2. Your roster is crosschecked against a direct-source database of every applicable exclusion & sanction authority, as well as a few others considered industry-standard.
3. Clearance investigations are carried out to objectively verify all potential exclusions are false. In some cases, we verify an exclusion is true.
4. A screening report is generated every time which you can access from your Venops dashboard. There’s no additional cost for storing and archiving your screening reports.
5. Screening is unlimited, so you can support pre-hire screening as needed, or as a means of updating your roster when you need it.

For clarification, you can screen any roster without providing PII to view the results. However, federal and state exclusion & sanction authorities utilize SSN and DOB for objective identification of individuals, so potential exclusion matches can’t be cleared without it. 

Venops not only identifies possible exclusions – it also verifies the exclusion status for you. To do that, Venops needs the identifying information (PII) used for that particular exclusion/sanction source wherever possible.

This is a statement we hear often enough to address it in our FAQ. Yes – exclusion screening still applies. This is why:

The OIG mandate not only includes exclusion screening to identify excluded parties, but also the requirement to maintain an appropriate screening record. Your records of routine screening will do much to prove due diligence during any audits that occur.