Sanction Screening is the process of checking individuals and entities against various government sanction lists to identify those who are prohibited or restricted from participating in federal and state healthcare programs. These sanction lists include the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE), the System for Award Management (SAM) list, and various state Medicaid exclusion lists, among others.
Sanction screening is designed to help healthcare organizations verify that their employees, contractors, and vendors are not involved in any form of misconduct or activities that would make them ineligible to participate in federal or state healthcare programs. Regular sanction screenings are essential to ensure compliance with all relevant laws and regulations.
Why is Sanction Screening Important?
Sanction screening is a crucial practice for several reasons:
Ensuring Compliance with Regulations: Regular sanction screenings help healthcare organizations comply with federal and state regulations that require them to avoid employing or contracting with excluded or sanctioned individuals and entities. Failure to comply can result in severe penalties, including fines, loss of program eligibility, and reputational damage.
Protecting Program Integrity: Sanction screenings help maintain the integrity of federally funded healthcare programs by ensuring that excluded or restricted individuals and entities do not have access to program funds. This helps prevent fraud, waste, and abuse in the healthcare system.
Avoiding Penalties and Fines: Organizations that fail to conduct regular sanction screenings may face substantial penalties, including fines of up to $10,000 for each item or service provided by an excluded party. Additionally, they may be required to repay any payments received from federal healthcare programs for services rendered by excluded individuals or entities.
Maintaining Program Eligibility: Healthcare organizations found to employ or contract with sanctioned individuals or entities risk being excluded from participating in federal and state healthcare programs themselves. This exclusion can have significant financial and operational consequences.
Ensuring Ethical Practices: Conducting regular sanction screenings demonstrates a commitment to ethical practices and compliance with all applicable laws and regulations, which can enhance trust with patients, partners, and regulatory bodies.
Key Components of Sanction Screening
Sanction screening involves checking against multiple sanction lists to ensure comprehensive compliance. The key components of sanction screening include:
Federal Sanction Lists: These include the OIG LEIE, SAM, and the U.S. Department of Treasury's Office of Foreign Assets Control (OFAC) Specially Designated Nationals (SDN) List. These lists identify individuals and entities excluded or restricted from participating in federal programs.
State Sanction Lists: Each state maintains its own exclusion list, often focused on state-specific programs like Medicaid. Organizations must check these lists to ensure compliance with state regulations.
International Sanction Lists: For organizations operating globally, it may also be necessary to check international sanction lists, such as those maintained by the United Nations or the European Union.
Continuous Monitoring: Sanction lists are updated regularly, often monthly. Organizations need to conduct sanction screenings continuously to capture any new exclusions or changes.
How to Conduct Effective Sanction Screening
To conduct effective sanction screenings, healthcare organizations should implement the following steps:
Identify Relevant Sanction Lists: Determine which sanction lists are applicable to your organization, including federal, state, and any international lists that may be relevant.
Conduct Regular Screenings: Establish a schedule for regular sanction screenings, typically monthly, to ensure continuous compliance with all applicable regulations.
Utilize Automated Screening Tools: Automated sanction screening tools, such as Exclusion Guard, can streamline the process by automatically checking multiple sanction lists, providing real-time alerts, and generating comprehensive reports to ensure compliance.
Document All Screening Activities: Maintain detailed records of all sanction screenings, including dates, names checked, results, and any actions taken. This documentation is essential for demonstrating compliance during audits or investigations.
Sanction screening is a critical component of healthcare compliance that helps protect the integrity of federal and state healthcare programs. By regularly checking individuals and entities against multiple sanction lists, healthcare organizations can avoid penalties, maintain program eligibility, and demonstrate a commitment to ethical practices.
Incorporating sanction screening into your compliance strategy and using automated tools to streamline the process can help safeguard your organization against the risks associated with employing or contracting with sanctioned individuals or entities.