Category: Board Actions

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.

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).

Typhoon Data is Certified by the NCQA

Typhoon Data, a healthcare data solution provider, announced today it has received certification from the National Committee for Quality Assurance (NCQA), a private, non-profit organization dedicated to improving healthcare quality, for the following credentials verifications services;

License to Practice
DEA Registration
Medical Board Sanctions
Ongoing Monitoring
Medicaid/Medicare Sanctions

This credential verifies Typhoon Data’s use of industry best practices and demonstrates its commitment to quality improvement, increased performance measures, and better compliance data. Typhoon Data was built from the ground up applying knowledge gained from years of industry experience to provide the most effective and accurate solution available. Verification services designed to comply with NCQA credentialing standards demonstrates that Typhoon Data has the systems, process and personnel in place to thoroughly and accurately verify providers’ credentials and help health plan clients meet their accreditation goals.

Recognizing the critical nature of the services they provide, Typhoon Data determined that obtaining certification was a key business strategy. Typhoon Data was built with the customer in mind, and offers integration or turnkey solutions, customization, exclusion data, and verification services. Typhoon Data has revolutionized the method for continuously monitoring compliance data. Typhoon Data is positioned to move the industry forward through innovation and by leveraging technology.

As a bootstrapped startup Typhoon Data has worked to establish sound policies and procedures, and to become an expert in credentialing and compliance. The management and operations teams have created systems that ensure complete, accurate, and timely data gathering and verification. Certification includes rigorous on-site evaluations conducted by a team of health care professionals and certified credentialing specialists. A national oversight committee of physicians analyzes the team’s finding and determines certification based on the CVO’s compliance with NCQA standards.

About Typhoon Data

Typhoon Data is transforming the data industry through automation and partnerships. We make it possible to search for license, exclusion, and board action data in a more efficient and cost effective way. Because our processes are based in the future, we have the ability to offer better products than our competitors at a fraction of the price and in a standardized way that brings new meaning to Compliance Monitoring.

We efficiently handle monthly batching or quarterly reviews, we are constantly monitoring, making it possible for you to truly get the complete picture on your health care staff.

About the National Committee for Quality Assurance (NCQA)

NCQA is a private, non-profit organization dedicated to improving healthcare quality. NCQA accredits and certifies a wide range of healthcare organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Web site (http://www.ncqa.org) contains information to help consumers, employers and others make more informed health care choices.

For the original version on PRWeb visit: http://www.prweb.com/releases/2017/01/prweb13989788.htm

Risk: It’s All About Time!

usa-flag-map

Medical Provider data with regards to Medicare and Medicaid exclusions can be tricky from a timing perspective. Even though the Office of Inspector General (OIG) with the List of Excluded Individuals and Entities (LEIE) were created to attack the ever changing problem of Medicare Fraud, it can often be a trailing indicator. There are rules of inclusion that require the OIG to follow a process that often takes time. Once a name or entity is entered into the data set, it is only a matter of checking the names against the dataset either through the government website, downloading the data or using a Consumer Reporting Agency (CRA) or similar service.

The OIG is focused on this issue and does a good job to keep the data up to date as possible and it is a large effort indeed considering the estimate of Medical licensed professions is just under 12 million according to the most recent estimates.

But what about the risk of those organizations that hires or does business with individuals or entities who have been convicted of a crime or state boards who have taken action but the license is unaffected or the OIG has not issued an exclusion? What is the time factor of when the offender or subject shows up on the LEIE list? Or are the various State Medicaid lists timelier? Not all states have Medicaid sanctions lists but the number has grown to 37 states with the recent addition of Iowa and Georgia this year.

Let’s take for example the case of CNA Kenisha Abeene. Her name showed up on the Nevada List of Sanctioned Excluded Providers in early 2014. Her name did not appear on OIG until January of the following year.

As a matter of process, TyphoonDATA pulls press releases from various Law Enforcement sites, both state and federal to gauge how fast the issues get across the spectrum of reporting entities which include Federal sources like OIG, DEA Disbarment, SAM.gov and state exclusion sites like https://dch.georgia.gov/georgia-oig-exclusions-list. Also the issues might initially surface in Licensing repositories like Department of Professional Licensing or DOPL (pronounced “Dop-Pull”) or specific board sites. Unfortunately, the states are not uniform in the approach to posting and size does matter with regards to provider type licenses. There are more Doctors and Nurses in this country so often those boards have daily updates.

For example, in the case of Physician Cyrus Sajadi, Dr. Sajadi was charged in 2012 and his name was all over the DOJ and other news sites. But, there was no action granted until 2015. Meaning his license stayed clear and without action for three years, making it possible for him to practice when he was known to have committed fraud. Leaving any organization that hadn’t known of his fraud opens them up to potential risk. For three years, his name did not pop up on the OIG or any state exclusion site. Knowing as much about your employees or potential employees as possible will cut away at your exposure to fraud or potential fines.

Moving from state to state also presents challenges. Doing a Social Security (SSN) trace often reveals multiple states the subject has lived, worked or studied. Name changes, especially in marital status, are also a driving issue. The exclusion is a post that is current at the time of posting and personal identifying information or Pii is needed to capture the action or exclusion. Often the board action is “thin file” or lacking identifiers so Sherlock Holmes will be needed to crack the case.

And last but not least this is not a one and done issue. Continuous monitoring not periodic batching is recommended. The on-going update process of data should be at a minimum monthly and some sites (Medi–CAL) have some provider types where daily updates are done.

Here are examples of delayed reporting:

INDIVIDUAL

PROVIDER TYPE

DATE OF BOARD ACTION

DATE OF APPEARANCE IN THE OIG LEIE

H, AMBER DAWN

Pharmacy Technician

10/25/2013

1/20/2015

B, BENJAMIN

CNA

12/22/2014

5/20/2015

P, THOMAS A

Pharmacy Technician

11/22/2013

1/20/2015

A, DAVID

LPN

5/15/2006

8/20/2006

A, KENISHA

CNA

3/27/2014

1/20/2015

 

Multi-State Licenses and Board Actions

I recently read an article on ProPublica (Read article here) about nurses who skip from state to state after receiving disciplinary actions. This has been and continues to be a huge weakness in the compliance industry.

When Craig Peske was fired from his nursing position in his home state in Wisconsin, and subsequently received an action against his license as well as six felony counts of narcotic possession, he used his “multi-state license” to get a job as a traveling nurse in North Carolina.

His license in North Carolina didn’t have an action against it, it was active and clear. It even surprised him when he checked on it. But, because his license was active, he had the ability to work as a nurse in North Carolina.

His license being clear in North Carolina could have been due to a lag time in getting the discipline on his record. Or because it’s possible that even with a multi-state license, the boards of separate states don’t communicate.

While I’m sure the hospital in North Carolina did their due diligence in searching his North Carolina license to confirm he was active. I believe they probably also searched for him in SAM and OIG to confirm he had no federal actions against him. What was missed, though, was that they clearly didn’t check into his Wisconsin license. The reason for this could range from Craig Peske not releasing the information that he did in fact have a license in another state. Or that their only requirement for employment is to have a free and clear license in the state of the employment.

There are many reasons why licenses for a practitioner can and will stay active when the practitioner shouldn’t be working in the healthcare industry anymore. Employing a nurse that has stolen painkillers at another facility creates a weak spot in your facility. It can open your facility up to being sanctioned or fined. It can put your patients in jeopardy as well.

And, although, most employers ask for every practitioner to disclose their actions, organizations can’t always trust employees to do so. As healthcare organizations, we need to gather as much knowledge about our practitioners as we can to protect our patients and our organization from fraud. I believe we owe this to the people out there trusting us to provide them with quality medical care.

That’s why TyphoonDATA’s product is so invaluable. With each new employee that is hired, you can search TyphoonDATA’s comprehensive database and see if there has been an action against them from a multitude of different sources. Or you can select one of our monitoring products, so with each refresh of the data, your employees are searched against the database. If a new record that matches your employee is found, you will be notified and TyphoonDATA does a verification to confirm or deny whether or not your employee is free and clear. It gives facilities and organizations just a little more comfort in knowing their employees are sanction free.

TyphoonDATA has packages that range from Basic Exclusion (searches against the OIG database) to Standard Plus (Searches against our entire database, including board actions, federal and state exclusions, and medicare opt-outs) to Premium Exclusion searches (Includes everything in Standard Plus, with a license check as well, to guarantee that their license is active and clear). All of our products are available as just a stand alone search, or with verification, or as a monitoring product.

Take a look at our products here.