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Complete and Accurate Provider Data is the Key to Protecting Patients

June 7, 2018

Verisys solves the complexity of full provider transparency through a centralized and comprehensive data platform that keeps patients safe and prevents providers from practicing medicine when they are not in good standing.

A recent story on the cover of USA Today via the Milwaukee Journal Sentinal/MedPage (5/30/18) by Matt Wynn and John Fauber entitled, “Doctors lose licenses but stay employed” talks about $25.8 million being paid out to doctors with impaired licenses in 2015.

The article pointed out a breakdown in patient protection, especially for Medicare seniors on behalf of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), and referred to that population as “sitting ducks” when they are exposed to providers who continue to practice regardless of their licenses being impaired.

Providers undergoing disciplinary action often surrender their license in one state and bounce to another state to get a new one. It’s a scheme that relies on the fact that state licensing boards do not communicate across state lines or taxonomies.

One of Verisys’ propriety platforms, Verified License Search and Status (VLSS), provides a complete view of a provider in real time by identifying a provider’s current and historical licenses across every jurisdiction as well as license type and the status of each of those whether it be restricted, inactive, voluntarily surrendered, expired, or in good standing. Verisys acquires the licensing information direct from the primary source—each state licensing board and does not rely on providers self reporting.

In addition to the licensing platform, other primary sources that Verisys continuously accesses include sex offender and abuse registries, OFAC, SAM, OIG, SSA DMF and Verisys’ own FACIS (Fraud Abuse Control Information System). These data sets, plus the thousands of others that Verisys monitors are critical to give a complete, thorough and accurate 360-degree profile of any provider.

The article references that the OIG relies exclusively on its own data, the List of Excluded Individuals/Entities (LEIE) as well as the National Provider Data Bank (NPDB) to determine reimbursement to providers. Using these limited data sets pose many challenges. As data often resides at local and regional levels, using a self-reported data set will come with many gaps and time lags and is limited in number of records and depth of data.

The Verisys data platform includes millions of provider and entity records and is coupled with proprietary matching logic and primary source verification to give the most complete and accurate profile on any provider. Verisys then monitors continuously for any changes to a provider profile.

There is a better way to bridge the lack of federal resources needed to prevent bad actors from collecting federal reimbursement and endangering patients. Verisys has been leveraging technology and building data platforms for more than 20 years that results in the most comprehensive provider profiles. This data is initially verified, continuously monitored and then aggregated with updated reports available daily.


Verisys has resolved a significant challenge in the health care arena—the gap that is created when data exists in various locations, is outdated, and difficult to access and decipher. Verisys offers total transparency by delivering easy to comprehend data through a single, secure source supporting a proactive versus reactive approach to reimbursement.

Universal use of Verisys’ data platform remediates the two-pronged threat to health care today: 1) jeopardizing patient safety by allowing providers with impaired licenses to treat patients; and, 2) the “pay and chase” conundrum that pays out first and then attempts to recover, with further expense and use of resources.

The Verisys way: achieving patient safety through a 360-degree view of licensed providers – complete, accurate and always up to date.

Juliette Willard Written by Susen Sawatzki
Healthcare Industry Expert
Muse. Writer. Publisher. Producer. Creator of Inspiring Narratives.
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