A Simple Guide to OIG Screening for Healthcare Businesses

Managing a healthcare organization can be overwhelming, as providing quality patient care is your foremost goal. However, you also have an enormous amount of behind-the-scenes paperwork and compliance to complete. Part of your hiring and managing of your healthcare workforce involves the OIG screening process. If you are not familiar with OIG screening or want to learn more about it, then you are in the right place! We’ll go over what OIG screening is, why it is important, and how OIG screening protects your organization.

What is OIG Screening?

Simply put, OIG screening is a process to perform background checks against healthcare workers and vendors. OIG stands for the Office of Inspector General, which is a federal agency that oversees the integrity of government healthcare programs such as Medicare and Medicaid in order to protect them from fraud, waste, and abuse. 

When you conduct OIG screening, you will check either a potential hire, current employee, or third-party vendor against federal databases to ensure they have a legitimate right to work in the healthcare field. If an employee has a history of abusing patients, committing healthcare fraud, or has lost their medical credentials, OIG will take action to prevent them from engaging in federal health programs.

The Exclusions List OIG is the most valuable asset that you will be using throughout this process. The Exclusions List Indeed is referred to as the “List of Excluded Individuals/Entities” (LEIE); this is a constantly updated database that is maintained by the federal government.

If a doctor, or nurse, or billing agency performs any form of illegal or extremely unethical conduct, their name will be added to this database. Therefore, if you were to hire someone from this list, you would be taking an enormous chance with your business. Moreover, if your business receives any federal funds through Medicare or Medicaid, you will be barred by law from employing anyone from this list. This means that regardless of whether the individual is a highly skilled surgeon or just a front desk assistant, they cannot work in your business.

The Importance of a Routine OIG CheckYou might think that checking a person’s background once during the hiring process is enough. However, an OIG check should not be a one-time event. The government updates its exclusion database every single month. An employee who had a clean record in January might end up on the list in June due to an ongoing investigation.

Because of this, conducting a regular, monthly OIG check is the best practice for any healthcare facility. It gives you peace of mind knowing that your entire staff remains compliant with federal laws year-round.

How Do Sanction Checks Fit In?

While the OIG focuses on federal exclusions, it is also important to remember sanction checks. A sanction check is a slightly broader process. It looks at disciplinary actions taken by state medical boards. For example, a nurse might have their license suspended in one state (a sanction) before they officially make it onto the federal OIG list. By performing thorough sanction checks alongside your standard OIG process, you catch potential red flags before they turn into major legal headaches.

Final Note

OIG screening protects your medical practice as opposed to being another excessive, unnecessary task to perform and not completing an OIG screen on your personnel exposes you to potential monetary damages representing thousands of dollars for each violation.

To achieve these efforts, implement proactive measures to monitor the exclusions list, conduct regular background checks, and maintain compliance; thus protecting your patients, preserving your reputation and protecting the financial health of your organization. The message is simple:  Do the "OIG screening" with staff and be in compliance so that you may continue with the work you love, which is the provision of quality healthcare.

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