Screening ServicesHealthcare sanctions Checks

The US Department of Health and Human Service Office of the Inspector General (OIG) maintains a list of individuals who are excluded from participation in federal and state healthcare programs—it’s called the OIG Exclusions list. Healthcare organizations that provide care to patients who receive benefits under these programs, such as Medicare and Medicaid, are prohibited from employing sanctioned or excluded individuals or vendors who are included on the OIG Exclusions list (also known as the healthcare sanctions list).

The healthcare sanctions list includes persons convicted of:

• Making fraudulent Medicare or Medicaid claims
• Committing other forms of healthcare fraud
• Neglecting or abusing patients, or other patient-related medical misconduct
• Theft, financial fraud, or illegal distribution of controlled substances

The amount of time an individual’s name stays on the healthcare sanctions list varies according to the nature of the sanctions against them. Some criminal convictions require staying on the list for specific durations (for example, five or 10 years). In cases of suspended or revoked licenses, individuals can request to be removed from the list once their licenses have been restored. Removal from the list is never automatic; in all instances, listed persons must formally ask to have their names taken off the list—a process the OIG calls reinstatement.

The OIG’s sanctions database is open to the public and searchable from any web browser. Entering the name of a company or individual into the database allows searching for listed exclusions. Matching results can be verified by entering a Social Security number (or employer ID number in the case of companies and contractors).

A word of caution: While the free OIG sanctions search tool is useful for job candidates who may be concerned they’re on the exclusions list, it’s less reliable for employers looking to hiring workers for healthcare-related positions. Social Security numbers are not available for every entry in the exclusions list, so verification is not always possible—and a candidate intent on skirting the system could always supply a bogus Social Security number.

Aside from avoiding hiring persons with criminal histories or questionable credentials, there are strong financial reasons to avoid overlooking required healthcare exclusions.

The OIG can impose fines (known as civil monetary penalties, or CMPs) of $10,000 per violation on companies that hire or do business with persons on the sanctions list.

And there are risks to being overly cautious about exclusions, as well: Common names may yield multiple matches in the system, and refusing to hire a candidate based on a misidentification could be grounds for an anti-discrimination lawsuit.

Healthcare sanctions searches are an important part of a comprehensive pre-employment screening. Combining a sanctions search with Social Security number verification and other crosschecks can prevent the kinds of misidentification that may occur when an OIG sanctions search is the only screen used.

Many healthcare employers opt to extend their sanctions checks beyond the minimum required by federal law, looking beyond the OIG Exclusion list for professional sanctions and convictions at the state level. GoodHire takes the following three-tiered approach, which is similar to the Fraud and Abuse Control Information System (FACIS) searches used by many professional background check companies.

In addition to an OIG database search, a Level 1 search uncovers infractions, including license suspensions, recorded in dozens of other federal databases, such as those maintained by the Veteran’s Administration, Food and Drug Administration, and Department of Homeland Security.

A Level 2 search expands on a Level 1 check by searching databases maintained by 38 states, listing individuals that have been excluded from Medicaid coverage and their grounds for doing so. A Level 2 search also includes states’ lists of individuals who are ineligible for Medicare coverage because they voluntarily opted out of the program.

A Level 3 search encompasses everything included in a Level 2 search, but also searches the medical-board records in states that permit it, uncovering any disciplinary actions against a candidate, and also searches additional state-level abuse databases.

The Patriot Act legislation, passed in the aftermath of the 9/11 attacks, includes provisions to take steps for preventing suspected terrorists and enemy states from abusing US funds. To that end, the Office of Foreign Asset Control (OFAC), a branch of the US Treasury Department, maintains a database of individuals and organizations barred from conducting business with US companies. The rules also forbid US companies from hiring individuals on the OFAC sanctions list.

Like the OIG sanctions list, OFAC’s database is available for public use on the web, but it’s more complicated than the OIG tool—and penalties for misusing it are more severe as well.

OFAC violations, which encompass crimes such as arms smuggling and money laundering along with hiring unauthorized individuals, can command penalties as high as $1 million and jail sentences of up to 20 years.

Some background check providers, including GoodHire, include OFAC sanctions searches in its Standard criminal background check package. If a candidate turns up on an OFAC screen, the screening report will provide that information, and provide the candidate with an opportunity to explain the conviction.

The logic behind healthcare sanctions searches is easy for hiring managers to understand, but the details of conducting them are tricky, despite the availability of public databases. For many hiring managers, it makes sense to trust the process to experts in employment screening and compliance with fair-hiring regulations.

GoodHire’s employment screening services and healthcare sanctions checks can simplify the process by delivering reports in an easy-to-read dashboard.