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 date with the latest changes and additions.
Nearly all health care organizations receive federal payments through CMS, HHS, GSA, and many others. Restrictions and penalties for improper payments are harsh and noncompliance can put organizations at serious financial and reputational risk.
Here’s what’s included in a GSA/OIG background check and how these databases can be used to meet federal and state requirements for a universal background check.
What is the GSA?
The General Services Administration is an independent agency of the United States government established in 1949 to help manage and support the basic functioning of federal agencies.
What is included in a GSA/OIG background check?
Completing a GSA/OIG background check is the first line of defense for any health care provider that receives federal funds. Providers who appear on an exclusion list are not eligible for payments or reimbursements, and any payments made to these providers put the organization at risk. There are several key databases that health care organizations use: List of Excluded Providers and Entities, System for Award Management, and the National Practitioner Data Bank.
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has created and maintains an exclusion database with individuals convicted of federal health care program fraud, patient abuse, licensing board actions, and defaulting on health education assistance loans. This database is called the List of Excluded Providers and Entities.
The Government Services Administration (GSA) is responsible for broader oversight into federal contracts. They maintain a list of entities excluded from doing business with the federal government that is not limited to HHS.
The Excluded Parties List System (EPLS) identifies entities prohibited from receiving federal contracts and certain subcontracts, including health care program funding or reimbursement, and from some federal financial and nonfinancial assistance and benefits. As of 2012, this database is now rolled into the more comprehensive System for Award Management (SAM) list.
Lastly, The National Practitioner Data Bank (NPDB) is a web-based repository of reports on medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers. These reports prevent practitioners from moving state to state and concealing important information about their history. Only eligible entities are able to report to and/or query the NPDB. The reports included in the NPDB include adverse action reports, medical malpractice payment reports, and judgment or convictions records.
Using FACIS queries for health care provider screening
With the thousands of different data sources available and millions of records in those databases, completing a universal background screening for health care providers would be extremely time-consuming and inefficient as a manual process. Many vendors use a combination of different databases to create a picture of a provider’s history, credentials, and eligibility for federal payments.
FACIS® (Fraud Abuse Control Information System) is a Verisys owned and maintained data platform consisting of primary source content from federal and state sources for exclusions, sanctions, debarments, and disciplinary actions against health care professionals and entities for all published license types and publishing jurisdictions. FACIS is the gold standard data platform and a nationally used database.
A FACIS search can be performed at different levels. All searches include reported information that meets the OIG Compliance Program Guidelines for sanction screening. FACIS Level II includes various sanction and exclusion data for one state and FACIS Level III includes information from federal agencies and databases as well as agencies in all 50 states.
FACIS and other Verisys products including CheckMedic® allow our clients to meet and exceed state and federal guidelines for their provider searches and ongoing monitoring of their population. Health care organizations are tasked with protecting and serving patients at their most vulnerable.
Hiring and employing providers that share that mission for their patients is the goal of our clients, and at Verisys, we work to make that as simple and efficient as possible. Our products and services give our clients peace of mind to know that their patients and providers are protected.
|Written by Juliette Willard
Healthcare Communications Specialist
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