Why Transparency Matters in Healthcare: Understanding Financial Tracking and Background Safety

We rely on our doctors, hospitals, clinics, etc., to provide us with reliable and honest care, so it's essential that we trust the people we are seeing for healthcare. The healthcare system's level of trust is the number one priority for everyone involved; both consumers and providers. To keep this high level of trust in place, there are numerous government sponsored mechanisms that have been set in place to ensure that there is transparency in how money is being spent on patients and that every medical professional has a clean history of professional behaviour.

As complicated as the Healthcare system may appear, the tools used to ensure genuineness and honesty within it, are quite simple. We will review how everyday, patients, taxpayers, and medical clinics, are protected by systems like Open Payments CMS and background vetting.

Preventing Bad Actors from Entering the Healthcare Field

A hospital, private physician's office, and pharmacy all have a significant obligation to hire people who are honest. The Office of Inspector General (OIG) maintains a publicly available list of individuals and organizations who have been barred from participating in federal health care programs (Medicare, Medicaid, etc.). To avoid hiring individuals who are on that list, all employers must conduct an OIG Screening.

OIG Screening is a form of specialized background-checking that is unique to the medical industry. Those who have committed health care fraud, have committed abuse against patients, and have been convicted of other felonies who are involved in the provision of health care will find themselves placed on the government exclusion list. Therefore, by performing an OIG Screening, a health care facility is not only safeguarding its patients from potential danger, but it is also safeguarding itself against the risk of enormous fines from the government. OIG Screening is an important part of compliance with federal regulations in health care, and therefore, OIG Screening should be performed as a matter of course and will be routine in any type of medical facility's human resources operation.

The Mechanics of Verification

So, how does a facility actually know if someone is on the banned list? They find out by running an OIG Check. This straightforward process involves searching an applicant’s or employee's name against the federal database to see if there is a match.

Running a single OIG Check before hiring someone is a great start, but it isn't enough to stay compliant in the long run. Because the federal exclusion list is updated by the government every single month, a medical worker who was cleared in January might be added to the banned list in February due to a recent legal issue.

For this reason, a responsible medical practice will perform an OIG Check on all of their employees, contractors, and vendors on a monthly basis. If a routine OIG Check suddenly reveals that a long-time employee has been banned, the facility must take immediate action. Continuing to employ that person can result in thousands of dollars in fines per violation, which is why regular testing is so critical. By making an OIG Check a monthly habit, medical administrators ensure that their safety standards never slip over time.

Shedding Light on Financial Relationships

In addition to preventing fraud & ensuring patient safety, There is another side of healthcare transparency that relates to money flow. Patients have a right to know whether their doctor has received money, gifts or travel from drug & medical device manufacturers. Enter Open Payments CMS.

Open Payments CMS is a national database that is accessible to the public and managed by The Centers for Medicare & Medicaid Services. Drug & medical device manufacturers are mandated by federal law to report any payment and or gifts to physicians and hospitals. All payments must be tracked and reported in the Open Payments CMS, including payments for physician consultant work, grant funding for research, and provided lunches to the physician's office staff, etc.

Open Payments CMS is beautiful because the public can access the database. Patients can enter their physician's name and find out if there are any potential conflicts of interest regarding the medications your physician prescribes. This empowers patients to ask their physician informed questions regarding their healthcare.

A Complete Picture of Healthcare Integrity

At first glance, catching fraud and tracking industry payments might seem like two very different tasks, but they share the exact same goal: protecting the integrity of the medical system.

When a clinic commits to a reliable OIG Screening program, they are actively guarding their front door against people with a history of unethical behavior. At the same time, the Open Payments CMS database acts as a clear window into the financial motivations that might influence medical treatments. It doesn't mean a doctor is doing anything illegal or wrong by accepting a research grant or speaking fee, but the transparency ensures that patients are fully informed.

In the end, all of these tools exist to protect the public. The healthcare system is massive, making it vital to have simple, effective safety nets in place. By keeping track of financial ties and consistently verifying the backgrounds of medical staff, the healthcare system becomes safer, more honest, and much easier for patients to trust.