• News
  • Contact
  • Provider and client login
  • 0Shopping Cart
Valenz
  • Why Vālenz
    • Why Valenz
    • Healthcare Ecosystem Optimization Platform
    • V-Rated Solution
    • Case Studies & White Papers
  • Solutions
    • Network Design
      • Valenz Access
        • Access Contracted Network
        • Access Navigated Network
        • Access Open Solution
        • Access Assured Payment
        • Access Amplified
        • Access MEC Solution
        • Access Eco Complete
    • Care Management
      • Valenz Care
        • Utilization Management
        • Case Management
        • Disease Management
        • NaVcare
        • Care Value Optimizer
        • Telehealth
        • Pharmacy Solutions
    • Claim Management
      • Valenz Claim
        • Valenz ProteKHt™
        • Renal Dialysis Specialty Solution
        • Air Ambulance Solution
        • VMS® Market-Sensitive Repricing
        • CaptiV
    • Compliance & Payment Integrity
      • Valenz Assurance
        • VPoint™ Credentialing
        • EPStaffCheck™
        • ClaimScrub™
        • DataTank™
        • ABN Assistant™
  • Decision Enablement
    • Decision Enablement
    • Data & Transparency
  • Company
    • About Us
    • Leadership
    • Careers
  • News
  • Contact
  • Client & Provider Login
  • Search
  • Menu Menu

Searching State Exclusion Lists: Why It Matters for Assured Compliance

December 3, 2020/in Featured, Valenz Assurance/by kamryn cain

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.

Share this entry
  • Share on Twitter
  • Share on LinkedIn
  • Share by Mail
https://www.valenzhealth.com/wp-content/uploads/2020/12/State-Exclusion-600x432-1.jpg 432 600 kamryn cain https://www.valenzhealth.com/wp-content/uploads/2023/01/valenz-logo-1-23-3.png kamryn cain2020-12-03 14:45:462020-12-04 22:36:45Searching State Exclusion Lists: Why It Matters for Assured Compliance

Categories

  • Announcements (80)
  • Events (18)
  • Featured (94)
  • Integrations (5)
  • Misc. (4)
  • Press (40)
  • Valenz Access (4)
  • Valenz Assurance (4)
  • Valenz Care (9)
  • Valenz Claim (5)

Archive

  • March 2023 (1)
  • February 2023 (4)
  • January 2023 (1)
  • December 2022 (1)
  • November 2022 (3)
  • October 2022 (1)
  • September 2022 (2)
  • August 2022 (3)
  • July 2022 (2)
  • June 2022 (2)
  • May 2022 (2)
  • March 2022 (2)
  • February 2022 (5)
  • January 2022 (2)
  • December 2021 (5)
  • November 2021 (1)
  • October 2021 (3)
  • September 2021 (3)
  • August 2021 (5)
  • July 2021 (2)
  • June 2021 (2)
  • April 2021 (4)
  • March 2021 (1)
  • February 2021 (1)
  • December 2020 (4)
  • November 2020 (1)
  • October 2020 (1)
  • September 2020 (2)
  • August 2020 (2)
  • June 2020 (1)
  • May 2020 (3)
  • April 2020 (2)
  • March 2020 (3)
  • February 2020 (4)
  • January 2020 (4)
  • December 2019 (2)
  • November 2019 (3)
  • October 2019 (1)
  • September 2019 (1)
  • January 2019 (1)
  • June 2018 (1)
  • August 2017 (1)

23048 N. 15th Ave
Phoenix, AZ 85027
United States of America

Toll-Free: (866) 762-4455
Main Fax: (888) 452-6512

Solutions

Vālenz Access
Vālenz Care
Vālenz Claim
Vālenz Assurance

About Valenz

Power of the Ecosystem
Company Values
History
Leadership
Sales Team
Careers

Resources

Case Studies
White Papers
Webinars
News

For Clients

Login
Help Center
v-Lens Portal

Terms and Conditions

Privacy Policy

Social Media Policy

© Vālenz®

Building an Effective Compliance Management Program: What You Need to KnowPortrait of Randy Dorshorst, Vice President, Ecosystem Success at Vālenz Portrait of Patty Onion, Vice President, Claims Operations at VālenzVālenz Appoints Dorshorst, Onion to Leadership Team
Scroll to top