//Guest Blog: Federal Exclusion

We are happy to introduce a guest blogger. Jon McCollum is the founder of Verify Comply, the federal and state exclusion and debarment screening. Prior to founding Verify Comply, Jon served as the Corporate Compliance Officer at one of the nation’s largest medical billing and practice management companies. Jon studied Computer Science at The University of North Texas, is a Microsoft Certified Professional, a Six Sigma Green Belt, and a Certified Compliance Professional. Jon is also a member of the Healthcare Compliance Association and the Health Ethics Trust.

Federal Exclusion – Insights from an Insider

I’m the founder of Verify Comply and we help companies navigate the world of State and Federal exclusion and debarment. In my job I talk a lot, but I try to listen even more. I often hear the same themes from prospective clients, so I thought that sharing some of these reflections might be helpful. 

Why Do I Need to Screen Everybody?

Misconceptions seem to exist around what it takes to be placed on an exclusion list. I hear this one a lot: “I’ve known him for years and he’s never been in trouble, so how could he be excluded?” It’s unfortunately not that simple. Federal healthcare exclusion comes in two flavors – Mandatory and Permissive.  “Mandatory Exclusions” are fairly well known – these are typically actions that result from criminal offenses such as Medicare/Medicaid fraud and patient abuse and neglect.  “Permissive Exclusions,” on the other hand, can be sneaky. Did you know that exclusion can occur for defaulting on health education loans? It’s true! The government doesn’t pay those who don’t pay them. Exclusions can pop-up at any time, even for folks you would never suspect. The point?  Screen everyone, and screen them monthly – even if you know them.

Will the Government Really Find Out?

So you identified an excluded party on staff. Now what? Well, you’re supposed to self-report, but human nature almost always raises the question, “How will they know?” The answer is surprisingly simple. One’s first thought might be the use of tax returns, but the examples I’ve seen are even simpler. When an excluded party applies for reinstatement, the Feds ask for employment history! So, the answer to the question posed here is, “yes, the government really will find out.” You aren’t doing your staff member or yourself any favors by not reporting.

What do Mistakes Cost?

Civil Monetary Penalties are the answer – and the fed’s authority to issue treble (three times) the value of the infraction. Fines are calculated differently based on the nature of services provided by the excluded party and the duration of the event. However, what you should know is the government has great liberty as to how penalties are levied, and it’s been shown that prompt self-reporting can significantly reduce the fines. And, of course, don’t forget that the government is not the only entity out there that might seek redress. If you are a subcontractor or lower tier contractor, using excluded individuals is probably a breach of contract. Losing your contract, on top of Civil Monetary Penalties, makes careful screening and self-reporting crucial.

How Can I Comply with Monthly Checks?

Checking the debarment/exclusion lists must be done up-front and monthly for all of your employees and contractors. Whether you have 300 or 3000 or 30,000+ that need screening, this task might seem daunting, at best. The good news here is that screening up front and on a monthly basis is pretty easy and cost efficient, especially with OIG Exclusion List Services like Verify Comply that do much of the work for you. While the federal (and state, where applicable) databases are free to search, they aren’t very efficient (think: searching each person manually on at least two different databases). One client screening just 350 people estimated this would take a single employee around 40 hours each month. Commercial services, however, allow you to search all the databases at once, often pulling data from a spreadsheet or from integration with your payroll software or service provider. That same client reports that the monthly screens only takes on average just one hour per month using our services.