Getting the Fullest Picture of Healthcare Sanctions and Exclusions

The COVID-19 pandemic exposed the vulnerabilities within our healthcare system, with bed shortages and a lack of life-saving equipment available when Americans needed them most. But there is another problem facing the healthcare industry: a staffing shortage. Nurses, in particular, are leaving the industry in droves, citing burnout or more lucrative opportunities. This exodus has left healthcare organizations desperate for new hires, with little time to waste.

But new healthcare hires, more than in any other industry, need to be thoroughly screened and continuously monitored post hire. To keep Americans safe, organizations that employ workers in this sector must perform their due diligence. They must ensure that each of their providers/practitioners is properly screened and licensed, has a clean history with their licensing board, and is not excluded from any state or federal programs.

What is a healthcare exclusion?

There are two federal databases relevant to healthcare sanction and exclusion information. The Office of the Inspector General (OIG), an agency within the U.S. Department of Health and Human Services (DHHS), is responsible for preventing and detecting fraud, waste, and abuse. The OIG not only oversees the Medicare and Medicaid programs but also more than 100 other HHS institutions, including the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Food and Drug Administration (FDA). The OIG maintains a healthcare exclusions database called the “List of Excluded Individuals and Entities” (LEIE).

The Systems for Award Management (SAM) is an official government website managed by the General Services Administration (GSA). The SAM database inherited its exclusionary database from the GSA’s “Excluded Parties List System” (EPLS), which was folded into SAM in 2012. The SAM database receives and maintains exclusionary data from all federal agencies, including the OIG exclusion list. The SAM database is an “umbrella” of various federal agency exclusion data – it includes any data reported on the OIG’s exclusions list and also maintains its own database for exclusions outside the healthcare industry.

The OIG and SAM databases are the closest thing to national data sources for sanctions and exclusions that exist in the healthcare industry, but they are not comprehensive. The OIG excludes individuals and entities based on reports from State Medicaid programs regarding actions taken by medical boards for each state. However, not everything pertaining to a board action or State Medicaid exclusion is reported to the OIG and SAM. These potential gaps make it critical to use a more comprehensive search that includes State Medicaid and state board actions.

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Why it matters

Healthcare entities and employers can be held liable for any individual on their employee roster who is excluded by the OIG, including individuals excluded for a low-level offense such as defaulting on student loans. Keeping close watch for individuals who are excluded for any reason, regardless of severity, is of utmost importance. But the most severe damage to company brand and reputation comes when well-educated and ostensibly experienced doctors, nurses, and surgeons abuse the system and their patients. This sort of abuse falls well within the bounds of exclusionary action from the OIG, meaning practitioners who abuse patients through malpractice or negligence should have their licenses suspended or revoked.

One particular case illustrates why it is critical to check all available data sources. Steven Svabek was an orthopedic surgeon in Indiana who lost his surgical privileges in the state of Indiana after two surgeries that “fell below the standard of care” and left two individuals with severe nerve damage, according to state and court records.

Svabek lost his surgical privileges at two different Indianapolis hospitals but did not reveal this to the Indiana Medical Board. Despite receiving a fine, his license was not suspended or revoked by his fellow physicians on the state board. Svabek continued practicing and accruing state board actions for two decades because healthcare organizations did not check the full range of available datasets to ensure he had no actions taken against his license by any state boards.

The bottom line

All organizations must develop processes to ensure corporate compliance, but it is exceptionally urgent for healthcare entities. Healthcare organizations are treating more Americans during this crisis than ever before, and it’s necessary to ensure that each provider/practitioner properly screened and licensed. By taking this step, the urgent need to hire and credential healthcare staff won’t coincide with a rise in avoidable tragedies, and healthcare organizations can ensure continued public confidence in our healthcare system during this challenging time.

Lorinda Walters

Author

Lorinda Walters

Lorinda Walters is Director of Healthcare Screening Solutions at Appriss Insights. She has more than 20 years of experience in the healthcare screening industry.

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