How OIG Exclusion List Monitoring Promotes Patient Safety

How would you tell a patient that the physician who they recently visited was federally prohibited from practicing at the time? A difficult and damaging conversation to say the least. It’s one you can avoid with effective OIG exclusion list monitoring.

Routine and frequent exclusions monitoring helps make sure that issue never arises. The Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE) serves as a critical safeguard, protecting patients from barred providers while ensuring the financial integrity of healthcare organizations.

Failing to monitor this list can have severe consequences, jeopardizing patient well-being — and prompting uncomfortable conversations — as well as substantial financial losses.

Understanding the OIG Exclusion List

The OIG LEIE identifies individuals and entities that are prohibited from participating in federally-funded healthcare programs. This list includes individuals convicted of healthcare fraud, patient abuse, or other serious violations. OIG exclusion list monitoring is vital in maintaining compliance with Centers for Medicare & Medicaid Services (CMS) regulations, as well as National Committee for Quality Assurance (NCQA) credentialing standards, among other federal healthcare provisions.

Hiring or contracting with excluded parties can damage an organization’s compliance status and lead to reputational damage and severe financial penalties. It’s estimated that employing someone on the OIG exclusion list can cost your organization anywhere from $10,000 to $50,000 per violation depending on the circumstances. Claims submitted for services rendered by excluded individuals or entities will likely be denied or payment will be recouped – spurring even further financial loss.

Working with individuals and entities on the exclusion list also vastly compromises patient safety. Would you want a provider who’s been disbarred due to patient abuse or malpractice providing your care? We wouldn’t either.

By completing continuous monitoring of the OIG exclusion list, healthcare organizations can prevent the hiring of unqualified or excluded individuals, reducing the risk of harm and ensuring that patients receive care from qualified and competent providers. This proactive approach safeguards those under your care and builds trust between patients and healthcare providers.

Exclusion Checks vs. Exclusion Monitoring

Same concept, different strategy, different outcomes. Many organizations perform exclusion checks only at key moments – when a provider is hired, during reaccreditation, or at the time of license renewal.

Unlike these checks, OIG exclusion list monitoring means reviewing the list on a regular and frequent basis. The OIG recommends monthly exclusion monitoring, checking the exclusions list every month for every provider. This method helps you catch problems faster and guarantees that patients aren’t treated by an excluded provider during the time it went unchecked.

Rather than relying on infrequent checks, an OIG exclusion list monitoring system provides continuous oversight and alerts organizations when exclusionary status changes.

MedTrainer offers automatic exclusion monitoring — every week for SAM and every 30 days for all other databases — making compliance seamless and reducing the administrative burden on healthcare organizations.

At the end of the day, it’s monitoring that will save your organization from compromised patient safety and denied reimbursements.

Tools and Best Practices for Effective OIG Exclusion List Monitoring

Checking exclusions databases for every provider every month is unmanageable without the right tools and best practices. If just one person is manually completing exclusion checks for 100 providers, it would be a full-time job! Here’s what you need to make continuous OIG exclusion list monitoring a reality:

Automation

It’s not reasonable to think that you can manually check exclusions for every provider on a regular basis. In fact, even NCQA has turned its focus on continuous monitoring, based on the technology now available. Automation can take care of the tedious back-and-forth from website to website, freeing up staff time to review any exclusions found by the automated system.

Automation Best Practices

Ensure the automated exclusion checks follow an NCQA-compliant schedule
More than just OIG exclusion list monitoring should be included — the SAM (System for Award Management) database and many other states should also be checked
Choose an automated system that is actionable — meaning notifications are sent when an individual or entity’s exclusion status changes

Tracking and Reporting

An auditor or payer will want to see proof of your organization’s most recent OIG exclusion list monitoring check for specified individuals. Real-time tracking and reporting simplify this request and give you confidence in your organization’s compliance.

Tracking and Reporting Best Practices

Customize reports to show the information your leadership and auditors need
Ensure you have the ability to save and schedule exclusions reports to email either internally or externally
Automatically track each individual’s exclusion checks within a provider profile for quick access

Original Source Verification

When you’re looking at the impact of an exclusion’s impact on patient safety, reimbursement, and your organization’s revenue, you want to be sure the information is coming straight from the original source and that it has been verified by someone in your organization.

Verification Best Practices

Automated notifications when an exclusion status changes
Tracking of the change within the provider’s profile and easy access to additional information
Include comments from the person who verifies the exclusion, so all information is together for future reference

MedTrainer’s healthcare exclusion monitoring software will reduce monthly screening tasks and help eliminate any gaps in data and promptly screen new employees as your workforce evolves (a win not only for your organization’s healthcare compliance but also for busy HR professionals).

Steps to Implement OIG Exclusion List Monitoring in Your Organization

Successfully maintaining OIG exclusion list monitoring requires organizations to establish clear protocols and assign responsibilities, whether that’s to specific individuals or dedicated teams. Without a defined process and delegation, exclusions can go unnoticed, putting both patient safety and reimbursement eligibility at risk.

It’s also important to schedule routine audits of the exclusion list. As discussed above, there is a stark difference between exclusion checks and monitoring — conduct audits consistently and frequently.

Given the complexity and frequency of exclusion updates, having exclusion monitoring software with automation can significantly ease the burden. Automation enhances efficiency, providing real-time alerts and seamless tracking to prevent any oversight.

By streamlining the process to track state, OIG, and additional exclusion data, software like MedTrainer empowers organizations to maintain a high standard while protecting patients, reputation, and revenue.

Monitor More, With Less

OIG exclusion list monitoring is essential for protecting patients and safeguarding the financial health of healthcare organizations. By implementing effective and consistent monitoring practices while removing the manual burden with automated technology, healthcare organizations can proactively monitor exclusion lists more effectively, helping to mitigate risks, ensure compliance, and create a culture of patient safety and trust.

See how MedTrainer can help automate exclusion monitoring today.