It’s a new year…

complianceHappy New Year!!!

Once those words are uttered at 12:01 a.m. on January 1st, we’re all promised improvement. We promise it to ourselves with resolutions and we’re promised it from the people around us. Most resolutions boil down to a single idea: trimming the fat.

Usually, we mean this literally. Whether we’re talking about losing a couple pounds from the holidays, or losing a couple handfuls of pounds. We all want to trim the fat from the previous year. Read More It’s a new year…

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.

SAM.gov Exclusions – What Are They, and Where do They Come From?

SAM.gov publishes an exclusion file used by many organizations for screening and/or compliance purposes. This exclusion file replaces the former EPLS files as of November, 2012. The SAM exclusion file receives regular updates and contains the collective exclusion reporting of over 80 different federal agencies totaling to approximately 130,000 exclusion records. An exclusion record from SAM.gov indicates that the individual or organization listed is disqualified from receiving any federal government contracts. S.A.M. stands for System for Award Management. This system is used for any party seeking to be awarded a federal government contract and become a federal vendor or supplier.

Let’s take a look at the break-down of the SAM.gov exclusions to see where most of the information comes from. As seen in the chart below, almost 1/2 of the SAM.gov exclusion records come from the Department of Health and Human Services’ OIG LEIE exclusion list. The top 6 contributors to the SAM.gov file makeup over 90% of its total records. The chart below only shows the top 27 federal agencies that report to SAM, there are many more which have made small record contributions.

Each agency that reports to the SAM exclusion system is responsible for the accuracy of its records and the information they contain. Exclusions records have a “type” and a “termination date”. The types are generally “Prohibition/Restriction” or “Ineligible”. In some cases the type may indicate “Proceedings Pending” or “Proceedings Completed”. These types give a little insight into the status of the investigation resulting in exclusion. The termination date in the record indicates the shelf-life of the exclusion. In some cases, a future date is present. This means that once that date is reached, the party on record is no longer excluded. In many cases, the word “Indefinite” is seen in the termination date. An indefinite exclusion never expires and can only be removed at the digression of the reporting agency. If specific conditions or criteria are met, the excluding agency may remove the exclusion. SAM does not publish a reinstatement list, non-excluded parties are simply removed from the updated file. Some reporting agencies (such as the OIG) do maintain their own reinstatement lists.

 

SAM Pie3

TyphoonDATA offers data and compliance solutions that include the SAM.gov exclusions file and much more.

To speak with TyphoonDATA directly, please contact:

Richard Rupert, VP Compliance Solutions
Office: 800.780.5901 extension 705
rrupert@typhoondata.com

Slipping Through the Cracks in the Process

More and more public watchdog groups, press and user groups are finding holes in the system that may be of concern to those who are hiring or credentialing medical providers.  The article dated June 30, 2014 from NPR demonstrates the complexities and timing issues.  Some providers are able to circumvent the billing process and continue to receive payment for years after being acted upon by the various state medical boards. http://www.npr.org/blogs/health/2014/06/20/323889329/sanctions-common-against-doctors-with-odd-medicare-billing?ft=1&f=1001

Credit Reporting Agencies focusing on hiring, compliance groups and credentialing organizations have the mission to surface issues beyond just the exclusion data repositories like the Office of the Inspector General (OIG) or one of the many Federal sites that track violators.  As you know, being excluded from the Federal Medicare process is only one element of the wider net that is needed to get all the data to make a hiring, risk or just plain due diligence decision.

The problem is often just timing.  A scenario might be a provider is arrested for a crime and adjudication begins.  Maybe a state medical board reviews the incident and takes action.  The various states may jump into action and exclude the provider from receiving Medicaid payments which is administered from the states even though the money comes primarily from the Federal tax dollars.  The license may be affected at the board level and it make take time to get into the exclusion process.  Hearings have to be set and conclusions reviewed.

It is the due process that takes time and we all appreciate the need for it.  But if you are a hiring entity or compliance group you may get caught in the cracks.  The key is to check the various Federal, State and board actions that will blanket the whole process.

It is possible to get an accurate, up to date picture and TyphoonDATA has a solution with will cast a wide net, verify the false positives and close the cracks into a simple to use click process.

If you would like to discuss, call us at 800.780.5901 or email us at RRupert@typhoondata.com or SSkyhawk@typhoondata.com .  We would love to help you with your mission.

 

Lean Thinking and the Art of Creating Value in the Screening Industry

By Kim M. Kerr, CEO, TyphoonDATA

I am a firm believer and activist for Lean Thinking in any business I have worked in since the day I heard of the simple, commonsense approach to the workplace improvement process.  This includes the Screening and Data businesses.  Finding or creating a value stream for customers or clients has become a passion for me.  I had the opportunity to work with some great companies in the data and screening world that have embraced this approach to management and have seen dramatic improvements in the work environment, culture, and top and bottom lines of businesses of all shapes and sizes.  This process is an integral part of the culture at my current company.

I came from an investigative and event security background working for AT&T for many years performing internal investigations, event security including the 1996 Summer Olympic Games, leaving in 1998 after another “reengineering” that resulted in 15,000 managers getting the option for a benefit and retirement “buy out”.  I had seen literally years of downsizings and reengineering projects while managers struggled to catch a falling knife.  I watched thousands of workers either get laid off or reorganized into other jobs or departments in an attempt to find a level that could be supported by the customers.

What finally happened a few years after my departure was a series of mergers, sell offs and eventually a sale of AT&T to one of the Regional Telco’s.  The AT&T trademark, a brand known round the world, was garnered by this new business that is now a strong player in the cellular and business communications market.  It survived by being cut to ribbons over time.  The old AT&T died a death of a thousand cuts.

I have two family members who work in the manufacturing industry.  One is an Operations Manager for a packaging company; the other is an HR Manager for a bedding firm.  I was the Vice President and General Manager for LexisNexis Screening Solutions at the time and as I listen to those two use strange Japanese terms like “Gemba”, “Kaizen” and “Muda”, I began to wonder if Lean Principles would work in the screening and data business.  After some research I started putting this process in front of my Directors.  The results were incredible and the Principles of Lean are now an integral part of the DNA of any company I lead.

The topic is much too big to be covered in an overview article but I can give you some valuable concepts to think about.  First of all I used the term “big” not complicated.  Understanding the value your customer needs and wants from your products and services needs to be understood, articulated and embraced by all of your employees from the CEO to the rank and file.  This is defined as the “Value Stream”, a river of value that flows to your customers.

Along the stream is Muda or waste.  As an example, I was at a client location and saw employees standing around the copier.  They were creating copies of information to be used in the daily work.  I then noticed that all the work stations had two screens but the line was forming from a subset of the workers.  I asked my client what they did and he responded that they were involved in a value stream that fed into the screening report for several key clients.  It was a process outside the normal workflow.

I exclaimed, “Muda” to my client pointing at the copier clutch.  We looked at the wasted time of these employees standing by a copier.  The employees used that as a high tech water cooler to discuss last night’s game and where they were going after work.  So by just walking around the workplace or “Gemba” a trained observer saw a process improvement or “Kaizen” opportunity that had been gradually embraced as “just part of the process”.

The ultimate solutions was to review these processes in detail and the solutions which required a queuing change in the operations software and installing a third screen at two workstations, reassignment of two employees to other pressing processes.  In other words the value was doubled and waste was halved.

So here is my simple recommendation:  Buy a couple of books, Lean Thinking: Banish Waste and Create Wealth in Your Corporation by Womack, James P. and Jones, Daniel T. (Nov 23, 2010); and Gemba Kaizen: A Commonsense Approach to a Continuous Improvement Strategy 2/E by Masaaki Imai (May 23, 2012).  These books have a good framework for instituting Lean thinking into your business.

Have a meeting with your directors or lead managers and follow a few simple steps:

1)      Walk around the Workplace or “Gemba” and observe your employees.  Look at things like the workstation set up, which teams interact with which teams, use of ancillary devices like copiers or email processes.

2)      Ask your key managers what are the top three problems they spend most of their time on during the day?  Ask all the leaders to describe the issue.

3)      Pick one based on the biggest impact to one of the work groups.

4)      Break it into steps or Kaizen the process.  If need be, bring a “doer” into the discussion.

5)      Develop a theory of how the process could be changed and how the process can be measured.  If it can’t be measured, how can you know if you are successful?

6)      What is the investment in the change? – Development time, Project Management, outside resources.

7)      Make the changes.  Measure your success.

8)      Wash, rinse, repeat…

I also recommend instituting an accountability board in all your operations managers’ offices.  What is due in the next 24 hours?  Who is responsible and what is the deliverable?  I call this, “Moving the Ball”.

If you have a process you like, great!  But if you can’t seem to get your margins to grow or you are continually adding people during the good times and laying off others in the slow times, you may be a victim of the reengineering mind game.  Lean Thinking is anything but that.

There are companies or organizations Lean Thinking will NOT work.  It is in companies where the top leadership believes that all real good ideas and processes emanate from the top.  The Lean ship will sink on the sharp rocks of EGO surrounding the crystal tower of pure thought and reason.

Kim can be reached at KKerr@typhoondata.com

 

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.

Introducing TyphoonDATA, the Powerful New Alternative for Exclusion and Licensing Data Products

TyphoonDATA announced today that it has launched its innovative products and services for the healthcare and long term care markets.

Orem, UT (PRWEB) April 18, 2014

Founded by executives with decades of experience in screening and compliance, TyphoonData applies the latest technologies to improve timeliness and effectiveness in these healthcare processes. Kim Kerr, CEO states, “We found in conversations with industry leaders that a void existed that we knew we could fill. By working closely with the market and most importantly our customers, and through unmatched application of today’s most current technologies and processes, we provide the most accurate, timely, and cost effective alternative that far exceeds the typical expectations that are commonly found in the marketplace.”

TyphoonDATA collects comprehensive data sets and applies compliance, investigation, and due diligence best practices. The initial focus matches customer-supplied data against federal and state exclusions/sanctions sources to improve compliance results and license verification and monitoring. “We foster an environment of continuous process improvement in cooperation and collaboration with our customers,” adds Dan Decker, COO. “We have already identified and are planning a long pipeline of other data and underserved customer requirements that we intend on providing.”

“We pride ourselves in effective application of technology and services that exceed customer requirements and improve the industry,” adds Questin Francis, CTO. TyphoonDATA also provides an Applicant Tracking Systems (ATS) which can be used for candidate onboarding, enrollment, volunteer screening, tenant screening, pre-employment screening, and medical credentialing tracking.