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Screening
Credentialing
Verifications
Monitoring

Screening employees for exclusions protects your organization from civil monetary penalties of thousands, if not millions of dollars. These penalties are levied by the OIG against organizations who employ excluded providers or vendors, while receiving payments through a federal health care program.

An exclusion is an action taken by the Department of Health and Human Services, Office of Inspector General (HHS OIG) that prohibits an individual or entity from participating in any health care program that receives federal funds.

A federal exclusion is an action taken against an individual or entity by the OIG that excludes them from participating in Medicare and all other Federal health care programs. State exclusions are actions taken by individual states that prevent an individual or entity from receiving state Medicaid funds.

It’s important to note that not all state exclusions are reported to the OIG, so it’s beneficial to screen employees and vendors through all available federal and state exclusions lists.

Yes, the impact of an exclusion stretches beyond the individual or entity and is applicable to anyone who employs or contracts them while receiving government funds.

Anyone can be excluded by the OIG, even the cashier at your local pharmacy, so it’s important to be proactive and screen all of your employees, not just those who provide patient care.

A state board sanction is a disciplinary action that’s taken against an individual by a state licensing board. The severity of a sanction ranges from placing the provider on probation to a complete revocation of their license.

Screening for state board sanctions ensures that you’re not employing unlicensed or disciplined providers that put your organization at risk for fines and liability.

Not always. Sanctions are usually a result of some sort of professional misconduct which may or may not be severe enough to result in an exclusion.

Employers are responsible for providing patients with safe, reliable care. Those who fail to monitor or take the appropriate action against health care providers who have received a board sanction are fostering an environment that puts patients at risk, which can result in criminal and civil liabilities.

Employees and vendors are submitted through a FACIS® (Fraud and Abuse Control Information System) search, which screens them against thousands of disciplinary records collected from primary sources, on health care providers who have had an adverse action taken against them by a federal or state government regulatory body or state-licensing board.

Verisys credentials Medical providers through CheckMedic, which is a paperless, web-based solution that includes a verified and secure MedPass for each provider.

CheckMedic creates a verified and secure MedPass for providers that contains all of their credentials that can be managed and updated as needed, with the additional benefit of having the credentialing data continuously monitored.

Yes. In fact, the continuous monitoring of the credentialing data occurs through FACIS® and License Verifications, which adds the extra benefit of ensuring that providers aren’t excluded and that their licenses continue to be in good standing.

MedPasses contain all of the credentials and information needed by a medical staff, insurance company, or employer including:

• Education and Training*
Medical/Osteopathic School
Internships/residencies/fellowships
Board Certifications
Special Certificates

• Experience*
Hospital
Academic
Work
Peer reference contacts

• Licenses and Registrations*
State
DEA
UPIN
Business

• Other*
Health and all other required disclosures
Liability coverage
Insurances
Professional associations
Awards and commendations

• Reported Actions/FACIS level 3
DEA
License
Certifications
Exclusions, Sanctions and Disbarments

• ProviderCheck

• Verisys can be your agent for NPDB

*Primary Source Verified with dates where required

No, verifications aren’t automatically included in FACIS® searches unless they’re requested upon submission, however, they can be added to an initial search within seven business days after results are returned.

Verifications are recommended when a candidate search returns multiple FACIS® records that are considered probable matches.

Our experienced analysts conduct extensive research on the candidate and the FACIS® provider by gathering as much information as they can through primary sources to rule out or verify potential matches.

Verisys is a Certified Verification Organization (CVO) and is fully certified by the NCQA for 10 out of 10 verification services. Our verifications are performed by a team of specially trained analysts who have an accuracy rate of more than 99%.

Records are returned as either confirmed matches or non-matches. However, sometimes Verisys reports records as Unable To Determine (UTD). This usually occurs as a result of insufficient data provided for the individual or entity being searched or insufficient primary source data from the FACIS® record.

Confirmed matches show whether or not the FACIS® record is current or historical, a description of how the verification was performed, a pdf copy of the original action, as well as a copy of the provider’s license if the action was taken by a state licensing board.

Monitoring is an automated process offered by Verisys that screens employees and vendors for exclusions, debarments, and board disciplinary actions through FACIS® on an ongoing basis. This fulfills the recommendation of frequently screening employees and vendors for exclusions by the OIG and the Centers for Medicare & Medicaid Services (CMS).

Yes, employers can be held civilly and criminally liable if they facilitate unsafe patient care by employing health care professionals who have been sanctioned by a state licensing board due to unprofessional conduct.

Monitoring provides updated information on license statuses. This ensures that your employees are qualified and in good standing to practice medicine.

FACIS®, License Searches, Verified License Searches, the Abuse Registry, and the Sex Offender Registry.

FACIS® (Fraud and Abuse Control Information System) is a database maintained by Verisys that is comprised of current and historical records on health care providers, individuals and entities who have been sanctioned, debarred, excluded, or disciplined by federal or state government regulatory bodies and state-level licensing boards.

FACIS® Levels

FACIS® is separated into four levels that allow you to screen employees and vendors against different primary sources for exclusions, debarments, sanctions, and disciplinary actions.

FACIS® Level 1 meets the federal government’s minimum requirements as outlined in the OIG’s Compliance Program Guidance and includes: OIG, GSA, DEA, FDA, PHS, ORI, TRICARE and OFAC-SDN data (federal only) and Medicare Opt-Out.

FACIS® Level 1M is the recommended baseline and minimally required compliance search for candidates employed by organizations receiving government funding and includes: FACIS® Level 1 plus State Medicaid sanctions, 42 HEAT sources and 51 AG Notice and Release sources, and state-level procurement/contractor debarment sources.

FACIS® Level 2 brings into focus a specified state and includes: FACIS® Level 1 / 1M as well as additional state-level board / source information for one specified state.

FACIS® Level 3 is the gold standard of sanction and exclusionary searches. It includes: All sources included in FACIS 1 / 1M / 2 and the sanctioning boards from all 56 U.S. jurisdictions across all provider types. This accesses more than 3,000 sources.

At a minimum, FACIS® Level 1M, satisfies the recommendations set forth by the OIG and CMS by screening employees for federal and state exclusions and debarments, however many of our clients feel that the best practice is to take a more assertive approach by monitoring employees through FACIS® Level 3, because it protects them from the potential negative ramifications of employing individuals or vendors who are sanctioned by a state-level licensing board.

Verisys can monitor your populations annually, semi-annually, quarterly, monthly, or even continuously which reviews your population daily for any new data that’s retrieved from a primary source.

Population data needs to be entered into a .CSV (Comma Separated Values) template that’s provided by Verisys, then submitted through Verisys.com or through our SFTP (Secure File Transfer Protocol) site. We also offer several API integrations which can accept data and return results.

Still Have Questions?

We are thrilled to answer any questions you have about Verisys and the ways we can help your company with compliance, screening, verifications, credentialing and monitoring. We are also ready to answer questions you may have about the health care industry’s rules of compliance, what’s trending, and market changes that may alter the compliance landscape once again.

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