Month: May 2014

Top 5 reasons why providers make the OIG Exclusion List

It is a common assumption that the majority of providers on the OIG List of Excluded Individuals/Entities (LEIE) arrived there by defrauding the Medicare/Medicaid systems. It turns out that program related crimes are the second most common reason for exclusion. The most common reason why providers are excluded is due to license revocation or suspension. Below are the top 5 exclusion types and their descriptions:

OIG_breakdown

Drilling down on why a given provider’s license was revoked or suspended is not always easy. The reasons for these revocations and suspensions are many. Often times, the notes or minutes coming from the state licensing board do not specify a reason as the relinquishment may have been voluntary. Additional digging is often required to get the full picture.

Let’s look at an example:

Malissa Bender, was recently excluded on the OIG List. She was excluded because the Florida Board of Pharmacy granted a “Voluntary Relinquishment of License” tendered by the provider in October, 2013. Additional internet research reveals that Bender was arrested in July 2013, for stealing schedule II and III drugs from the Pharmacy where she worked. (see story)

With over 25,000 providers excluded for type 1128b4 you can see how tedious case-by-case research can become to get to the bottom of each exclusion. Fortunately, in most cases, simply knowing that the provider’s license is suspended or revoked should be enough for most employers to take action. In some cases, the reason for revocation or suspension will not be due to criminal action, or any other reason known to the employer. This fact emphasizes the need for employers to monitor an employee’s license and exclusion status.

TyphoonData offers solutions for license and exclusion monitoring.

If you would like to discuss our thoughts and solutions, give us a call at 800-780-5901.

TyphoonDATA Releases Powerful Capabilities to Assure Exclusion and License Monitoring Exceed Compliance Requirements

TyphoonDATA continues implementing its rapid automation and delivery model for exclusion and licensure source data search, monitoring, and verification for the healthcare and long term care markets.

Orem, Utah (PRWEB) May 15, 2014

TyphoonDATA’s discussions with health providers’ leadership and compliance organizations offered a consistent set of requirements from the onset. Dan Decker, Chief Operating Officer shares, “The market was clear in what they wanted and were not finding: access to comprehensive and expanding core and optional search and monitoring source data; comfort knowing these data are current, accurately presented, and complete; optimized verification processes from reductions in false positives, saving time, money, and worry; and predictable and cost-effective pricing.”

TyphoonDATA is fulfilling on these requirements and more. Questin Francis, Chief Technology Officer, continues, “We are not constrained by prior investments in technologies, and as such, are able to automate a significant number of processes that are done manually elsewhere.”TyphoonDATA’s data acquisition, normalization, and presentation is highly scalable. It optimizes consistency and quality, supports rapid acquisition and launch of additional data sources, and provides a platform for continuous expansion of services at greater speed and accuracy while containing costs.

“While exclusion and license monitoring is not unique, the way TyphoonDATA delivers is,” offers Kim Kerr, Chief Executive Officer. “We continue to expand the highest quality, most comprehensive background and compliance data sources and tools available through collaborative client relationships and continued improvements in automation and delivery. In doing so, TyphoonDATA provides ongoing monitoring more economically, more frequently, more completely, and more accurately than other options.”

Why should you check the STATE data as well as the FEDERAL sources!

Recently Bloomberg Businessweek published an article entitled, Why Medicare Keeps Paying Sketchy DoctorsBy John Tozzi, David Armstrong and Caroline Chen. (May 1, 2014). In this article the authors discuss the sometimes loose data pass from the States to the Federal regulators data sets. Tozzi specifically references Gary Ordog, a California Doctor who is on the California Department of Health Care Services Medi-Cal, Suspended and Ineligible Provider List but not currently listed in the List of Excluded Individuals and Entities published by the U.S. Department of Health & Human Services. A quick search of TyphoonDATA’s Standard Product returns a result for Dr. Ordog, meaning that this is an individual that may require additional research before you hire, contract or privilege.

Since my entry into this area of screening, I made the incorrect assumption that the data that originated at the various state levels transitioned into the various Federal repositories like HHS Office of Inspector General (OIG) and became a part of the LEIE listings. Although improved, they are not quite there as the article points out.

For those of you in the traditional Screening business, this is similar to county criminal data that moves to a state repository. There is sometimes a delay or it doesn’t quite make the pass.

In screening those individuals in the hiring motion or compliance motion, organizations are still using sometimes overlapping sources to make sure a problem is not invited through the door. So checking all the various sources is a business imperative especially with the new mandates under the Affordable Care Act (ACA) better known as Obamacare.

Although Exclusions are only published in the Private Sector in only 32 States (and growing!), the need to ensure your search effectiveness your provider needs to be aggressively layering the data sources and identity mapping. The data might be there, but the searching algorithms may be less than optimal.

TyphoonDATA has a solution we call our “STANDARD” product that would mitigate this happening at your organization. Give it a look!

If you would like to discuss our thoughts and solutions, give us a call at 800-780-5901 or contact me at kkerr@typhoondata.com.