Who is Typhoon Data?

Ask anyone on the street, “Who or what is Typhoon Data ” and they’ll most likely give you the same answer. “Some kind of tropical storm, right?” Well they’re not wrong, but not exactly right either. Typhoon Data is “…an organization who aims to help any company who employs  healthcare workers make sure that they are in compliance with state and federal laws of regulation..” -Questin Francis, CEO of Typhoon Data. Basically, we make sure the providers that they hire, are clean and pose little threat to the public.

This might come to a surprise, but some healthcare providers don’t always tell the truth. “You want to know about your health care providers. You want to know about their past and you can’t always trust them to tell the truth, so you need people like us to dig a little deeper and see what is going on.”  -Cassidy Cooper, Customer Experience Manager. You want to know if your doctor has any stipulations or past disciplinary actions taken against them. When these Healthcare providers slip between the cracks and are allowed to continue working, it risks the general public. Now before you run for the hills as society seems to be collapsing around you after this revelation, there’s no need to worry. While these healthcare providers might have actions against them, it’s all recorded somewhere on official databases, emphasis on somewhere. There’s a lot of data, and it’s not easily accessible. That’s where we come in. We have built a system that technology assists hand in hand with human work so that there’s less potential for that human error to occur. With faster turn around and fewer errors, we are able to find these individuals and bring their misconduct to light.

While there are other companies like Typhoon Data that do a similar job; we by far outpace the competition. “You go from these other providers who do similar work, their processes are just not as well done, so their turnaround time and their possibility of errors are significantly worse. Instead of turning around a verification that requires humanized quality control in about two to three days, about 8-10 hours business wise, they’re turning around in a couple of weeks. They are slower…there’s just a lot more potential for human error. It also helps that the customer portals that we provide for our larger customers such as Bryce and T-Bone, are more user friendly as well.” -Derek Jackson, Infrastructure Administrator. Basically we process the data faster, which tends to be more accurate as there’s less potential for human error, and the overall experience is more friendly because the interface is more user friendly.

Our future is bright. With more and more clients looking for a trustworthy compliance data provider, and with the unfortunate reality that Healthcare Provider malpractice continues to be rampant, there’s a lot of work to be done. there’s a lot of places that we need to reach, a lot of new ways to solve problems. “…another core part of typhoon data, [is] to not only solve those problems but to solve them in a more efficient, more technologically savvy and integrated way.” Questin Francis, CEO.

So what is Typhoon Data? Some kind of tropical storm, right? 😉

Compliance Best Practices

Monitoring excluded providers on an ongoing basis will alert organizations to potential risk of the Office of Inspector General (“OIG”) enforcement.  Once an excluded provider is identified on the List of Excluded Individuals/Entities (“LEIE”) by the OIG, the healthcare organization can take appropriate steps to mitigate and minimize civil monetary penalties (“CMP”) exposure.

Given the nature of the LEIE information, the following best practices will help organizations verify appropriate, actionable data:

  • The LEIE database is updated on a monthly basis so monitoring should occur at least monthly.
  • Because the OIG Database includes only the name known to OIG at the time the individual was excluded, any former names used by the individual (e.g., maiden name, previous married name, etc.) should be searched in addition to the individual’s current name.
  • An individual with a hyphenated name should be checked under each of the last names in the hyphenated name (e.g., Jane Smith-Jones should be checked under Jane Smith and Jane Jones, in addition to Jane Smith-Jones).
  • An organization should maintain documentation of the initial name search performed and any additional searches conducted in order to verify results of potential name matches.
  • Always remember to take the final step of identity verification using the Social Security Number (SSN) for an individual or Employer Identification Number (EIN) for an entity if available. It is not sufficient to simply find a matching name on the LEIE.
  • If a search result does not contain a DOB, UPIN, NPI, EIN, or SSN, it is not available from OIG. Organization may contact the OIG Exclusions Branch to determine if there is any other information available.(1)
  • The OIG recommends that to determine which persons should be screened against the LEIE, the provider should review each job category or contractual relationship to determine whether the item or service being provided is directly or indirectly, in whole or in part, payable by a Federal health care program. If the answer is yes, then the best mechanism for limiting CMP liability is to screen all persons that perform under that contract or that are in that job category.  Providers should determine whether or not to screen contractors, subcontractors, and the employees of contractors using the same analysis that they would for their own employees.(2)

References:

  1. https://oig.hhs.gov/exclusions/tips.asp
  2. https://oig.hhs.gov/exclusions/files/sab-05092013.pdf

OIG Compliance is the Key

When a healthcare organization is found to not be in compliance with laws or regulations, corporate integrity agreements (“CIA”) and civil monetary penalties (“CMP”) may be the unintended consequences.

Beginning in September 1999, the United States Department of Health and Human Services (“HHS”) and the Office of Inspector General (“OIG”) embarked on an initiative to prevent the submission of erroneous claims and combat fraud and abuse in the Federal health care programs through voluntary compliance efforts.  Submitting a false claim, or causing a false claim to be submitted, to a Federal health care program may subject the individual, the entity, or both to criminal prosecution, civil liability (including treble damages and penalties) under the False Claims Act, and exclusion from participation in Federal health care programs.(1)  

The OIG has the authority to exclude individuals and entities from Federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud.  Those that are excluded can receive no payment from Federal healthcare programs for any items or services they furnish, order, or prescribe.  This includes those that provide health benefits funded directly or indirectly by the United States (other than the Federal Employees Health Benefits Plan).

The OIG maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals/Entities (“LEIE”).  Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (“CMP”).  To avoid CMP liability, health care entities should routinely check the list to ensure that new hires and current employees are not on it.(2)

References:

  1. https://oig.hhs.gov/compliance/compliance-guidance/docs/complianceguidance/nhg_fr.pdf
  2. https://oig.hhs.gov/exclusions/index.asp

Happy New Year!

The new year is typically a time when we make resolutions to improve or maintain positive habits. Whether it’s simply to be a little kinder, or to learn a new skill, resolutions are a great way to take that first step into something better for yourself, and in some cases, your business. 

TyphoonDATA has a few resolutions this year. The first is to continuously improve our processes in day to day operations. The second is to add to our repertoire of automated sources. Finally, our third resolution is to give back to the community in valuable ways.

When you think about how a business should be run we often turn to numbers and statistics. Here at Typhoon, we think above and beyond that. Though we do value numbers and statistics. We also value job satisfaction, communication, and detail-oriented work. Everyone on our team has an important role to play. To improve day to day operations, we encourage our team to share ways in which our processes could be simplified or elevated.  

Automation makes life easy for our customers and for ourselves. It shoulders tasks that are more susceptible to human error. So improving current automation and adding to what we have is a no-brainer. We’ve added a new employee to our technology team late last year, and we have several initiatives to improve our automation and elevate our platform to the next level. 

Giving back to the community is a fairly new initiative for us. We believe acts of kindness not only help others but add to the culture of our company. We ended last year by volunteering at a local nursing home. This brought us together as a team and brought us so much joy. So this year, we’re planning and executing many more service projects all around our community in Orem, Utah.

Happy New Year from TyphoonDATA! We wish you the best in all your resolutions.

Holiday Celebrations with Typhoon Data

Here at Typhoon Data we’ve been getting into the holiday season by celebrating over a three day period, as we couldn’t contain our excitement for the holidays to just one day. On Thursday we had the opportunity to decorate stockings as a company. The stockings turned out great (with exception to my own) and the conversation was even better.

The festivities picked up again the following day by starting with lunch at Tucanos, which allowed us to celebrate the hard work we had put in this year and provide the opportunity to socialize with our coworkers. When lunch drew to a close we were given gifts that were generous and delicious. After all this we were addressed by Questin Francis (Our CEO) to thank us and congratulate the company on the hard work we had been doing all year.

After our lunch we were fortunate to spend a few hours decorating cookies, doing crafts and helping facilitate a Christmas party at Provo Rehabilitation and Nursing for some of the patients that are currently staying there. It was a nice way to spend the rest of the afternoon and celebrate the holidays by getting to know people and help them celebrate their holidays too.

The next Wednesday we had the opportunity to create gingerbread houses as part of the festivities and to get to know those we don’t frequently work with. The end results were creative and unique, one of our employees came up with a lengthy backstory to why their gingerbread spaceship (they took liberties with the resources they were given) should win. All in all, it was a fun activity for all those involved.

Happy Holidays from your friends at Typhoon Data!

The CMS Preclusion List and You

What is the CMS Preclusion List?

The Preclusion List is a list of prescribers and individuals or entities who fall within any of

the following categories:

(1) Are currently revoked from Medicare, are under an active reenrollment bar, and CMS has determined that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program; or

(2) Have engaged in behavior for which CMS could have revoked the prescriber, individual or entity to the extent applicable if they had been enrolled in Medicare, and CMS determines that the underlying conduct that would have led to the revocation is detrimental to the best interests of the Medicare program. Such conduct includes, but are not limited to, felony convictions and Office of Inspector General (OIG) exclusions.

Why was it created? 

The CMS-4182 Final Rule was created to make revisions to the Medicare Advantage (MA) program (Part C) and Prescription Drug Benefit Program (Part D) regulations based on our continued experience in the administration of the Part C and Part D programs and to implement certain provisions of the Comprehensive Addiction and Recovery Act and the 21st Century Cures Act.

Will I get access to it?

Did you have access to the Medicare Advantage (MA) program (Part C) and/or Prescription Drug Benefit Program (Part D) in the past? If so, then you can get access to this list by applying to receive access to the EDMI through CMS. Submit your application here

Who is required to search the CMS Preclusion List?

Preclusion List Requirements for Prescribers in Part D and Individuals and Entities in MA, Cost Plans, and PACE

This final rule will rescind current regulatory provisions that require prescribers of Part D drugs and providers of MA services and items to enroll in Medicare in order for the Part D drug or MA service or item to be covered. As a replacement, a Part D plan sponsor will be required to reject, or require its pharmacy benefit manager to reject, a pharmacy claim for a Part D drug if the individual who prescribed the drug is included on the ‘‘preclusion list.’’ Similarly, an MA service or item will not be covered if the provider that furnished the service or item is on the preclusion list. The preclusion list will consist of certain individuals and entities that are currently revoked from the Medicare program under 42 CFR 424.535 and are under an active reenrollment bar, or have engaged in behavior for which CMS could have revoked the individual or entity to the extent applicable if they had been enrolled in Medicare, and CMS determines that the underlying conduct that led, or would have led, to the revocation is detrimental to the best interests of the Medicare program. We believe that this change from an enrollment requirement to a preclusion list requirement will reduce the burden on Part D prescribers and MA providers without compromising our program integrity efforts.

Where can I get more information?

The CMS Preclusion List Homepage

Erin’s two cents:

The CMS preclusion list is not for background screening. It’s available to Part C and Part D prescribers. Its primary purpose is to eliminate the opioid epidemic. The creation of this new list is in response to the Comprehensive Addiction and Recovery Act of 2016 (CARA). There may be excluded providers on this list, however, those exclusions will also still be listed on the OIG. 


The Medicare Exclusion Database (MED) and You

We are often asked if we have the Medicare Exclusion Database (MED) in our system. We do not collect the MED directly from CMS, but we do have this data in our system. The reason for this is because we collect our data from the primary source, as the Office of Inspector General is the primary source, we do not see a need to collect this data from the CMS as well.

We are precise in our collection. We believe in quality over quantity here at Typhoon Data. We don’t see a need in collecting “Everything”. Instead, we collect the pertinent, actionable, and primary source records that can help you and your clients get a full and complete picture on your health care providers. We take pride in our knowledge of these sources.

Last week, we got official and final confirmation that collecting the MED is not necessary.

Exact verbiage from CMS in regards to the MED:

“The Medicare Exclusion Database (MED) is a national database populated with information from the Office of the Inspector General.”

Reviewing Sanctions – What does the word “sanction” really mean?

sanc·tion
ˈsaNG(k)SH(ə)n/
noun
a threatened penalty for disobeying a law or rule.
“a range of sanctions aimed at deterring insider abuse”

Sanction is a term that is often used when referring to databases like ours. I’m often asked “do you have a sanction database?” or “is this a sanction check?”

We do have sanctions in our dataset. For example, Office of Foreign Assets Control (OFAC) has many lists of sanctioned individuals.

However, it’s a common misconception that an entire dataset like ours is a Sanction Database or Sanction search. Sanctions usually refer to Financial Sanctions. Financial Sanctions are restrictive measures imposed on individuals or entities in an effort to curtail their activities and to exert pressure and influence on them.

Our focus at Typhoon Data is to assemble a data set of all Federal and State Exclusions and Board Disciplinary Actions. Many organizations publish critical information for our customers, and we gather all of it, including Opt out affidavits, abuse registries, and imposter lists.

Federal and State Exclusions are Individuals and Entities that are excluded from participation in Medicare, Medicaid and other federal and state healthcare programs.

Termination occurs when the Medicare program, a State Medicaid program, or CHIP has taken an action to revoke a provider’s billing privileges, a provider has exhausted all applicable appeal rights or the timeline for appeal has expired, and there is no expectation on the part of a provider or supplier or the Medicare program, State Medicaid program, or CHIP that the revocation is temporary.

Disciplinary Actions (aka Board Actions) is the language used to describe the types of actions that occur at a board level. These can be minor, like a fine or civil penalty. Or they can be major, like a revocation or suspension of a medical license.

The difference between these? Though these both are targeted to the medical world, Disciplinary Actions cannot occur unless you are licensed, or attempting to become licensed. However, anyone can become excluded. Many times, a severe enough action will result in an exclusion, however this is not always the case.

Our dataset has much more than just these sources. We have a myriad of sources that are going to help give you the complete picture on your provider. We include Medicare Opt-Out’s, Abuse Registries, License Conditions, Imposter Alerts, Federal and State Actions, Press Releases, etc. Often times all of these different types of data fall into one category. Sanctions.

It would appear that the term “sanction” has been adopted to include any or all of the possible actions taken by the Federal government, state governments, or boards. As has been noted the terminology used by the many reporting entities varies greatly including;
Exclusion
Termination
Board Action
Medicare Opt-Out
Abuse Registries
License Condition
Imposter List
Federal and State Action
Press Release

That’s why, when asked if we have a sanction dataset, I’m always careful to ask follow-up questions about what specific sources the customer might want or need. If my customer is unsure of what exactly they need, we try to always stay up to date on the compliance regulations so we can offer them exactly what they need to meet the standards.

Excluded in One Excluded in All

Terminated-copy

Excluded in one, Excluded in all

The Affordable Care Act section 6501 discusses “Termination” of a medical provider under Medicaid if Terminated Under Medicare, CHIP, or Other State Plan.

“Termination occurs when the Medicare program, a State Medicaid program, or CHIP has taken an action to revoke a provider’s billing privileges, a provider has exhausted all applicable appeal rights or the timeline for appeal has expired, and there is no expectation on the part of a provider or supplier or the Medicare program, State Medicaid program, or CHIP that the revocation is temporary. The requirement for termination based upon a termination in another program applies in cases where providers, suppliers, or eligible professionals were terminated or had their billing privileges revoked for cause which may include reasons based on fraud, integrity, or quality.”

We find important clarifying details in an informational bulletin published in May of 2011. One point made by the director of the CPI (Center for Program Integrity) addresses the “for cause” portion of this section. The statement reads “For cause may include, but is not limited to, termination for reasons based upon fraud, integrity, or quality. For cause does not include cases where a State terminates a Medicaid or CHIP provider as a result of a failure to submit claims due to inactivity.” Additionally if a provider voluntarily ends participation in the program this is not considered “for cause” except when the “voluntary” action is taken to avoid sanction. The end of billing privileges does not necessarily result in Termination

Another important clarification from this bulletin is that if a provider is “Terminated” in one state, then all other states must also terminate, and the duration of the termination should follow the terminating State’s law. They provide the following example for clarification; “State A terminates a provider and the length of termination is 3 years. A termination action is triggered in State B with regard to that same provider as a result of the State A termination action. State B’s length of termination is 1 year. The provider is not allowed to re-enroll in State B’s Medicaid program for a 1-year period as opposed to State A’s 3-year bar to re-enrollment.” We usually refer to this as the excluded in one excluded in all scenario.

A couple of other points worth mentioning. It is clarified that there is a difference between termination and exclusion. Termination happens at the state level for the reasons stated above. “Generally, “exclusion” from participation in a federal health care program, including Medicare, Medicaid, and CHIP is a penalty imposed on providers and suppliers by the Department’s Office of Inspector General (HHS-OIG). Individuals and entities may be excluded from participating in federal health care programs for misconduct ranging from fraud convictions to patient abuse to defaulting on health education loans.” While they are technically different situations the end result is the same, a provider’s involuntary departure from the Medicaid program or CHIP. Finally the information should be reported on at least a monthly basis to the HHS-OIG.

Want to review the bulletin? Here’s the link; https://downloads.cms.gov/cmsgov/archived-downloads/CMCSBulletins/downloads/6501-Term.pdf

Let’s Talk about Primary Source Data

What is a Primary Source?

A Primary Source is the original source repository or the source that legally issue licenses, discipline, education, training, or examination. A couple of examples of this in our industry are:

California Board of Registered Nursing
Office of Inspector General, U.S. Department of Health and Human Services (OIG)
Pharmacy Technician Certification Board (PTCB)
Centers for Medicare and Medicaid Services (CMS)

What is a Primary Source Data?

Primary Source Data is the license, certification, or disciplinary data directly from the original source. This means the data we collect is directly from the primary source. This data includes exclusion information, opt-out affidavits, license issuance, and disciplinary records. Another caveat to primary source data is we do not change, adjust, or modify the record found at the primary source.

Why is Primary Source Data Important?

Primary source data is important to your company as a way to confirm that your employee can be authorized to work for your facility.

The OIG has the authority to exclude individuals and entities from participation in federal healthcare programs. Any organization or individual who hires excluded parties may be subject to civil monetary penalties (CMP). To avoid these penalties, the LEIE recommends (as a part of the Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs) that you check their database upon hire, and on an ongoing monthly basis.

Primary Source data is not only important to us, it’s important to accrediting bodies (i.e. The Joint Commission, URAC) and exclusion bodies (i.e. OIG, GSA).