Recently Bloomberg Businessweek published an article entitled, Why Medicare Keeps Paying Sketchy Doctors, By 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 firstname.lastname@example.org.