3 Sanction and Exclusion Best Practices for 2023 in Healthcare Compliance
In the ever-evolving landscape of healthcare compliance, staying ahead of regulatory requirements and ensuring ethical practices is paramount. As we delve into 2023, the need to effectively manage sanctions and exclusions (S&E) lists has become even more critical. Failure to properly perform S&E activities can lead to severe fines, legal actions, and lasting damage to an organization's reputation. In this article, we will delve into three best practices that healthcare entities must embrace to navigate these challenges successfully.
1. Learning from Recent Examples:
Recent examples serve as sobering reminders of the repercussions of improperly performed S&E activities. In 2022, a major healthcare system faced a staggering $4.3 million fine for employing individuals excluded from federal healthcare programs. The oversight of not thoroughly screening employees against exclusion lists not only resulted in substantial financial penalties but also eroded public trust in the organization's commitment to compliance.
Similarly, a pharmaceutical company encountered a $12 million settlement due to marketing products through a sales representative who was excluded from federal programs. This case underscores the importance of extending S&E screenings beyond internal staff to encompass external partners and vendors.
2. Implementing Regular Checks:
In 2023, the focus must shift towards proactive S&E screenings that minimize compliance risks. Establishing a regular cadence for checks is essential. A recommended schedule includes:
Pre-Employment Checks: Screen all potential employees against federal and state exclusion lists before hiring to ensure your workforce is free from individuals with questionable backgrounds.
Monthly Checks: Conduct monthly exclusion list checks for existing employees, vendors, contractors, and any entities with whom you have an ongoing relationship. This ongoing vigilance helps to identify any changes in exclusion status promptly.
Contract Renewal Checks: Ensure that exclusion list screenings are part of the due diligence process when contracts with vendors or contractors are up for renewal. This practice prevents inadvertently engaging with excluded entities.
3. Key Items to Screen For and Important Lists:
While implementing these practices, it's crucial to screen for key items and utilize the most relevant exclusion lists. The following are items to focus on:
Federal and State Exclusion Lists: These encompass lists like the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE) and the General Services Administration (GSA) System for Award Management (SAM), which contain records of individuals or entities excluded from federal programs.
Sanctions Lists: Pay attention to sanctions lists such as those from the U.S. Department of the Treasury's Office of Foreign Assets Control (OFAC) and the United Nations Security Council. These lists identify individuals, entities, and countries subject to various sanctions.
Professional Licensing Checks: Ensure that employees and contractors hold valid licenses and certifications required for their roles.
Criminal Background Checks: While not exclusion lists per se, conducting criminal background checks is vital to identify any potential risks posed by individuals working in healthcare settings.
In conclusion, 2023 demands an unwavering commitment to effective sanction and exclusion practices in healthcare compliance. Recent examples underscore the far-reaching consequences of inadequate screenings. By adopting regular checks, embracing the recommended cadence, and focusing on key items and important lists, healthcare organizations can fortify their operations, preserve their reputation, and uphold patient trust. In a landscape of ever-changing regulations, maintaining a robust S&E compliance framework is non-negotiable. At Dagger Healthcare Solutions, we're dedicated to helping you navigate these challenges and build a compliant and thriving healthcare environment.
