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7 Things You Need to Know About the CMS Preclusion List

In 2019, the Centers for Medicare and Medicaid (CMS) published new rules for providers and plans. Among these new rules was the Medicare Preclusion List, which adds new restrictions on payments to certain providers. Here’s what you need to know about the CMS Preclusion List, what it means for health care providers, and how to…

Screening State Medicaid Exclusion Databases

Improper payments from the federal government to fraudulent providers is big business. In 2019, the estimated number of improper payments by Medicaid totaled $57.36 billion. The federal government has created guardrails to ensure that fraudulent providers and entities known to have perpetuated abuse do not receive payments. One of the most significant tools for preventing…

What Are the Types of OIG Exclusions?

One of the most effective tools the federal government has to prevent money from being paid on claims from fraud and kickback schemes is to withhold payments from providers and entities that have committed health care fraud or other serious crimes. Public money should be safeguarded and go toward providing essential, legitimate services and procedures…

Understanding California Exclusion Screening Requirements

On a federal level, certain providers, individuals, and organizations are barred from receiving payments from the federal government for committing certain violations. Over the years, these databases and lists have been run by individual government agencies and departments. Currently, two main databases exist: the List of Excluded Individuals/Entities (LEIE) and the System for Award Management….

Understanding a FACIS Level 3 Background Check

Patient safety increases when health care organizations thoroughly verify the identity, credentials, and backgrounds of their providers. The level of accuracy with which these screenings are conducted matters. Since there is not a consolidated list of bad actors and fraudulent individuals who are skilled at hiding their identities, having many data sources is critical to…

What is a SSN Trace Report and How to Use it

A background check is the fundamental first step in employment verification. For health care organizations, verifying the identity, history, and other important information about a provider is essential to patient safety. A social security number trace report is a component of the background check that provides information about the names, addresses, and dates of birth…

What is a GSA Background Check?

For health care organizations, patient safety is paramount. Ensuring that the providers who serve patients, some of our most vulnerable populations, are properly credentialed, verified, and have the necessary qualifications and training is only the beginning of a sound compliance program. Proper credentialing and verification means accessing the right data sources and keeping up to…

Federal Agencies Provide Valuable Data Used in Health Care Credentialing & Screening

Attorney Generals And Federal Agencies The U.S. Attorney General (AG) is the chief law enforcement officer of the Federal government as the head of the Department of Justice. The position is appointed by the President and sits within the Cabinet that also includes the Vice President and 15 of the President’s top advisors. The State…

What Is the OFAC Sanctions List?

Here’s what you need to know about the OFAC sanctions list — the searchable database of individuals and entities restricted from doing business with U.S. businesses and individuals. We’ll explore what it means for health care organizations, and how maintaining compliance reduces reputational, financial, and patient risk. What is OFAC? According to the U.S. Department…

Why ISO 9001:2015 is Critical for Compliance Excellence

When it comes to health care, quality matters. One of the hallmarks of quality control is the ability to identify problems and solve them efficiently without disruption to the customer or end-user. However, these processes aren’t necessarily easy to put into place or even to identify. That’s where ISO 900:2015 comes in. The International Standard…