Searching State Exclusion Lists: Why It Matters for Assured Compliance

If your profession involves compliance management, you know the Office of Inspector General’s List of Excluded Individuals/Entities (OIG LEIE) is the federal database for all Medicaid sanctions – and no doubt your team checks it regularly for sanctioned providers. However, many investigations are conducted by state Medicaid offices and do not always include federal participation. Is your compliance team checking for sanctions and exclusions at the state level as well? If not, they should be.

In fact, OIG Best Practices state that you should also search every state sanction and exclusion list that corresponds with your business or service delivery location(s) – meaning, all states where you operate or have a physical business presence. Some organizations are required to check all 41 state Medicaid sanction lists, but if yours is not one of them, our compliance experts recommend at least checking border states and any other state where the providers in your network or health system have practiced in the past.

Why? Because state actions may appear before federal listings, and in some cases, the states and federal databases do not fully synchronize their entries. But, to be clear, if a person or organization you do business with is excluded by your state, you will face the full threat of repercussions, for hiring and reimbursing them, even if they do not appear on the federal exclusion list.

What do those repercussions look like? In addition to the loss of your reimbursement funds plus interest, civil monetary penalties may apply – not to mention reputational damage and potential legal liability. When it comes to non-compliance, the risks and penalties can be great, so the time and costs associated with checking every applicable sanctions and exclusion list, including state lists, is well worth it.

Also worth noting: To screen thoroughly, you must search lists from state licensing and medical boards, as well as state and county disciplinary action lists and abuse registries (including state/local consumer affairs, addiction recovery lists and more). Checking all lists, not just the major ones, helps ensure compliance by alerting you to providers who may have had fines imposed or faced certain allegations but have not formally been sanctioned.

If you don’t have the internal manpower to ensure no stone is left unturned, good news: Affordable outsourcing options are available. At Vālenz Assurance, we offer a range of compliance software and support solutions to meet your needs and budget. To learn more about how we take the complexity out of compliance, call 888-395-9029.