In 1977, Congress passed, and the President signed into the law the Medicare-Medicaid Anti-Fraud and Abuse Amendments, Public Law 95-142. This legislation included several significant provisions, one of which mandated the exclusion of physicians and other practitioners convicted of program-related crimes from participation in Medicare and Medicaid (now codified at Section 1128 of the Social Security Act). This was followed in 1981 with Congressional enactment of the Civil Monetary Penalties Law, Public Law 97-35, to further address health care fraud and abuse.
For more than 45 years, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) has been delegated the responsibility for pursuing exclusion actions against individuals and entities that have been convicted of one or more enumerated crimes, engaged in certain improper conduct or have been subjected to an adverse licensure action. OIG uses its exclusion authority to protect Federal health care programs from individuals or entities “whose continued participation constitutes a risk to the programs and their beneficiaries.”
An OIG exclusion action is a final administrative proceeding by the OIG or any State Medicaid Program that has been imposed because the individual or entity has been found to pose unacceptable risks to patient safety and/or program fraud. As a result, federal health care programs such as Medicare, Medicaid, and TRICARE will not pay for any service provided — either directly or indirectly — by an excluded person or entity.
Providers of the Federal health care programs must ensure that their employees, contractors, and vendors are not excluded. The failure to do so can result in significant penalties.
By not screening your employees, vendors, and contractors for exclusions you are placing yourself at risk of hundreds of thousands of dollars in civil monetary penalties. Effective March 17, 2022, the maximum amount of civil monetary penalties that the OIG has the authority to impose can be up to $22,427 for each item or service furnished by an excluded person or entity.
Even if a provider is unaware that a person was excluded at the time the claim was made, OIG has issued guidance advising that such inadvertent violations must be reported and repaid. Additionally, any claim that might involve an excluded person or entity could potentially have False Claims Act implications under the Affordable Care Act if it is not dealt with in a timely and proper manner.
We offer providers an EASY and inexpensive solution to the complex problems associated with screening and verifying that none of your employees, contractors, agents and vendors have been excluded from participating as providers in any Federal or State healthcare programs. We are focused on meeting your specific needs. Currently, our proprietary software SAFERTM screens employees, vendors, agents and contractors through the Federal Databases (OIG’s LEIE and GSA’s SAM), as well as all available State Exclusion Databases.[i]
Many organizations have different screening needs. At Exclusion Screening, we are focused on meeting your specific needs. Currently, our proprietary software, SAFERTM screens employees, vendors, and contractors through the OIG and SAM Federal Databases, as well as through every State database. When one of these databases is updated, our proprietary software immediately updates our SAFERTM system with the new exclusion information. This helps ensure that each month, that your employees, contractors, and vendors are screened to verify that they have not excluded from participating in Federal and State healthcare programs.
Exclusion Screening uses its own proprietary software called SAFERTM. This is the most advanced exclusion screening software on the market today. Using complex algorithms, that are constantly changing to be even more precise and efficient, SAFERTM updates daily to add new Federal and State exclusion database information. Currently, our search features are more comprehensive and efficient than those that are provided even by OIG and SAM. Our all-in-one service checks and verifies all your employees, contractors, and vendors for you. While we are currently the national leaders for exclusionary screening, we are also very competitively priced. We constantly work to make our services affordable no matter how small or large your organization is. We work tirelessly to make sure you are given the best deal possible and that we quickly and efficiently help you with your screening needs no matter what they may be. Our commitment to our clients is that we will always be.
 Additional videos providing an overview of the services offered by Exclusion Screening can be viewed on our YouTube channel.
Are you unsure your screening requirements depending on your business and location? Our FREE Consultation has you covered. It includes: An overview of exclusions in addition to an overview of your exclusion requirements, and a demonstration of our product and service (SAFER) will be performed prior to a presentation of your personalized solutions. This consultation for your benefit only!