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Understanding New York Exclusion Screening Requirements

To protect patients and staff from providers, individuals, and organizations accused of committing health care violations, governments at the federal and state levels maintain databases of health care providers excluded from practicing. Health care entities are expected to check current and prospective employees against these lists regularly. On the federal level, the Office of the…

A 3-Step Guide to Understanding Health Care Fraud

Many Americans (including veterans and the elderly) rely on government-sponsored health care plans, but with increased health care spending, there is a higher risk of abuse of federal health care funds. In 2019, the DOJ reported recovering over $3 billion from just False Claims Act (FCA) cases; negligence or abuse of the government healthcare programs…

Onboarding Checklist for Physicians and Nurses

Hiring a new practitioner is a complex process for many health care entities. For a physician or nurse signing on as a new provider, adjusting to a new workplace can also be difficult. A clear onboarding process can make the transition easier for everyone. Although onboarding processes vary from one organization to another, every provider…

A Guide to Healthcare Sanctions and Screenings

Employing sanctioned providers and the CMP’s (Civil Monetary Penalties) that result from that can cost your organization millions of dollars and irreparably damage your reputation before you’ve even realized the error. Here’s why healthcare sanctions screenings are not only important but imperative. What Are Healthcare Sanctions and Screenings? A healthcare sanction is a disciplinary action…

What Is the FDA Debarment List?

What Happens to Providers on the FDA Debarment List? The U.S. Food and Drug Administration maintains a list of persons and individuals who are debarred, meaning they are effectively forbidden from working in the drug industry. The FDA adds an individual to the FDA Debarment list when the person has been convicted of a crime…

What Is the Global Watch List?

Global Watch List: Manage Risk and Streamline Compliance While the globalization of health care offers tremendous possibilities for good, it also brings significant risk. Especially in the wake of a global pandemic, medical resources and health care providers themselves will be in short supply. During this critical time, manage risk and streamline compliance with Global…

What is the OMIG State Exclusion Database?

The Office of the Medicaid Inspector General (OMIG) is a government entity that protects against Medicaid fraud. To keep governments, patients, and providers safe, OMIG keeps a database of providers and enrollees who have been accused of committing a crime related to health care services. OMIG adds practitioners to its list of Medicaid exclusions when…

What is FACIS? A Guide to the Fraud Abuse Control Information System

FACIS Level 1M Background Check A FACIS Level 1M background check is the recommended baseline and minimally required compliance search for candidates employed by organizations that receive any government funding for state or federal health care programs. FACIS Level 1M meets and exceeds the minimum standards set forth by the Office of Inspector General (OIG)…

What Is Hospital Credentialing?

Hospital credentialing is the process of verifying that a provider is qualified to provide medical services. Although credentialing can be expensive and time-consuming, it is legally required and assures quality and safety for patients. Done properly, hospital credentialing also protects providers and hospitals. Although credentialing and privileging are sometimes used interchangeably, they are different processes….

Understanding NPI Numbers and Their Importance in Preventing Health Care Fraud

What is an NPI Number? The National Provider Identifier (NPI) is a standard that establishes a unique health identifier for health care providers and entities. An NPI is a unique identification number created to improve the efficiency and effectiveness of electronic transmission of health information. The NPI Final Rule, published on January 23, 2004, established…