Are you doing business with providers, vendors, or employees who have been excluded from Medicare or other government program participation? EPStaffCheck™ allows you to simply and immediately verify that your staff and other business relationships are not Medicare, Medicaid, or State Excluded or Sanctioned Individuals or Entities. Perform individual verifications as well as automatic pre-scheduled or periodic batch lists. State-based exclusion, fraud, and sanction lists also available, as well as license verification and monitoring.
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Overview of the Excluded Provider Program
Pricing and Subscription Information
Best practices suggest, and many states require, that facilities recheck sanctions and exclusions on a monthly basis. We want to encourage facilities to perform checks on a regular basis, so that they are very quickly made aware of any potential exclusions - thus avoiding large repayments. We agree that clients should run at least a monthly batch check on all of their staff, providers, and contractors. Why? Because it takes no extra time to do it, costs you very little, and tells you what you need to know, when you need to know it.
Annual subscription, usage based:
- $495 for 36,000 searches per year
- $300 per additional block of 36,000 searches
- $130 per state sanction or licensing database (optional)
What is the Excluded Provider Program? Does it affect us?
The federal and state excluded provider programs affect every organization that receives federal or state dollars, for medical and health services rendered, social service funds, and grant programs. Excluded individuals may include those who commit fraud or program abuse, who neglect to pay back certain federal student loans, or who commit other violations of federal and state law, and as a result are excluded from performing any work for federal or state programs. Organizations are not permitted to hire those individuals to administer or provide services that are in any way reimbursed or paid for with those public dollars.
What are the federal guidelines on penalties if we unknowingly hire an excluded individual?
The law provides for penalties of up to $10,000 for each item or service furnished. The law also provides for up to three times the amount claimed for each item or service. The rule of thumb is that the penalty should not be less than twice the approximated amount of damages and costs sustained by the government, including investigation costs, prosecution, and administrative case review. To view recent OIG settlement summaries, visit Civil Monetary Penalties. Repayments, fines and penalties for organizations who unknowingly hire such excluded parties can quickly reach tens or hundreds of thousands of dollars.
It is therefore critical that all healthcare providers and organizations that contract with government organizations or who receive state or federal dollars, check all new-hires before employment. Organizations must also conduct periodic follow-up checks of all employees, contractors, and medical staff to ensure that no new exclusion activity is appearing for existing staff or vendors.
Is it difficult to do this checking on our own? How often do we need to do it?
As organizations have discovered trying to check multiple federal and state databases through manual web page searches and downloading manual databases, is very time-consuming for staff. It is also error-prone, and does not provide a strong audit trail, which is required to demonstrate a good-faith compliance effort.
Depending on what state you are in, you may be required to check all employees, vendors, contractors, and referring providers at least monthly. The average manual verification process takes 20-30 seconds for each employee, vendor, and provider -- quickly adding up to hours or days of wasted staff time every month. And the manual process requires that you review the same results over and over again, month after month. EPStaffCheck reduces this time to minutes per month, and eliminates reviewing the same results repeatedly.
What documentation should we have in case of an audit?
An audit trail should provide written proof of all names searched, the date they were initially searched and every subsequent date thereafter, a list of all possible matches that were reviewed, and the results of that review and the determination made.
EPStaffCheck makes your exclusion-checking process fast, easy, and ready for audit!
EPStaffCheck" is a low-cost, highly effective solution which will improve your compliance efforts, and reduce staff costs to perform these checks to only minutes per month. Our service monitors all of your subscribed federal and state databases and reports back to you in one simple format, eliminating the need to track multiple sources and run multiple checks.
A subscription to EPStaffCheck is only $495/year for federal-level checking, and includes 36,000 searches per year. The base subscription includes the following national exclusion lists and options:
- OIG LEIE (Office of Inspector General List of Excluded Individuals and Entities)
- GSA EPLS (General Service Administration's Excluded Party List System)
- SDN (Specially Designated Nationals)
- $495/year for OIG, GSA and SDN for 36,000 searches
- Add state-specific and license verification databases for only $130 each per year
EPStaffCheck Makes Searching Easy:
- Perform individual checks instantly -- no waiting hours or days for results
- Create (or upload your own) staff and vendor lists and schedule periodic automatic batch checks of all staff and contractors
- Easily mark results that you have reviewed and cleared, so they do not appear again unless there is new sanction activity
- Flexible and easy to use, requiring no experience or special training
- Intelligent search technology ensures fewer false negatives to reduce staff review time, while still returning all relevant possible matches
- Detailed information on all possible matches for quick and easy review
- Documentation for all searches is generated electronically to save and/or print
- Makes monthly, quarterly, or annual batch processing quick and easy (encouraging compliance!)
- Automate your staff batch processing and get weekly or monthly action updates on all current staff, vendors, and employees
EPStaffCheck is Accurate and Up-to-Date:
- Searches data from over 200 government agencies containing over 200,000 entries for all persons or businesses who may be excluded from government-funded programs
- Add state-specific databases for your state as needed
- Add license verification and monitoring databases as needed
- Database changes and updates are automatically performed daily, providing you with the most current information possible
- Easy data entry ensures fewer false negatives and false positives
- Possible matches include detailed information for your review
EPStaffCheck is a Web Application
- No software installation; accessible at any computer with a web connection, at any time, 24 hours/day, 7 days/week
- Prevent data loss and reinstallation of software; software and data is stored securely on our server and backed up daily
- FREE unlimited user support, training, and technical assistance included in subscription price
- All support provided by full-time YEI staff, from our offices in Ohio
- Access your data and search preferences through a secure, encrypted, password-protected system
Manuals, Product Sheets, and Training Videos
Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs
This updated Special Advisory Bulletin describes the scope and effect of the legal prohibition on payment by Federal health care programs for items or services furnished by an excluded person or at the medical direction or on the prescription of an excluded person.