Which exclusion list should I use to check employees and vendors, the OIG-LEIE or the GSA-SAM?
It is recommended that you check both the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) and the General Services Administration’s (GSA) System for Award Management (SAM) databases, as well as all of the publicly available State Exclusion Lists.
According to 42 CFR Part §455.436(b) — Federal database checks, State Medicaid agencies must:
(b) Check the Social Security Administration’s Death Master File, the National Plan and Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE), the System for Award Management (SAM), and any such other databases as the Secretary may prescribe.
How frequently should I check for exclusions and sanctions?
According to the OIG’s Special Advisory Bulletin issued in May 2013, the OIG recommends that healthcare organizations check their employees and contractors against the LEIE monthly.
According to 42 CFR Part §455.436(c)(2) — Federal database checks, State Medicaid agencies must:
Check the LEIE and SAM no less frequently than monthly.
Furthermore, monthly screening is mandatory in at least fourteen States, while many others strongly suggest that providers screen employees and vendors against their State list and the LEIE monthly.
Are there regulatory requirements for healthcare organizations to check for exclusions or sanctions?
Federal database checks — 42 CFR Part §455.436 regulations, all State Medicaid agencies must do all of the following:
(a) Confirm the identity and determine the exclusion status of providers and any person with an ownership or control interest or who is an agent or managing employee of the provider through routine checks of Federal databases.
(b) Check the Social Security Administration’s Death Master File, the National Plan and Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE), the System for Award Management (SAM) (formally the Excluded Parties List System (EPLS)), and any such other databases as the Secretary may prescribe.
(c)(1) Consult appropriate databases to confirm identity upon enrollment and re-enrollment; and
(c)(2) Check the LEIE and SAM (formerly the EPLS) no less frequently than monthly.
If your organization fails to screen for excluded individuals and entities, you could be subject to Civil Monetary Penalties (CMP).
Should an employee who was excluded in another state be terminated?
Section 6501 of the Affordable Care Act, Termination of Provider Participation Under Medicaid if Terminated Under Medicare or Other State Plan, amends section 1902(a)(39) of the Social Security Act (Act) and requires State Medicaid agencies to terminate the participation of any individual or entity if such individual or entity is terminated under Medicare or any other State Medicaid plan.
Although Section 6501 of the Affordable Care Act does not explicitly include terminations from CHIP, the CMS has required CHIP, through Federal regulations, to take similar action regarding termination of a provider that is also terminated or had its billing privileges terminated under Medicare or any State Medicaid plan.