Why Healthcare Sanctions Screening Is Crucial in 2024?

As reported from Georgia, Memorial Health, Inc. came to a settlement with the OIG (Office of Inspector General) for allegedly employing an excluded entity and violating the Civil Monetary Penalties Law. If healthcare sanctions screening had been in place, Memorial Health could have avoided paying more than a $200,000 fine and facing a reputational fall. The escalating rates of fraudulent activities in almost every industry have pushed compliance to be more stringent, particularly in the healthcare sector where it significantly impacts the wellness of patients.

Onboarding a healthcare professional who has been sanctioned or barred by the administrative authority as a result of violating rules and laws can put your organization under the consequences of non-compliance. Monetary penalties are inevitable, but non-compliance also brings a loss of trust and reputation. Staying compliant is challenging but not impossible and it comes with a healthcare sanctions check before hiring a medical official into a team.

In this digital journey, together we will explore different dimensions of sanctions checks in the healthcare industry and how we can ensure compliance in times of uncertainty. Let’s get into it.

5 Reasons Sanctions Checks Are Essential In Healthcare

Institutions that are responsible for the healthcare of human beings are obliged to maintain the standards and compliance parameters as guided by governing bodies. These standards and protocols not only ensure quality healthcare, and protection of patients but also smooth out business operations.

The Welfare of Patients is Protected

Professionals who are involved in providing healthcare facilities to people are supposed to be genuine, competent, and disciplined. If fraudulent or unethical people are allowed in the profession, it can harm the integrity, quality of health facilities, and protection of patients. On the other hand, filtering out such entities and ensuring a vigilant check can help healthcare institutions protect the welfare of patients.

Quality Standards of Care are Maintained

Getting medical treatment from professionals who are compliant and trustworthy not only boosts patient’s confidence in healthcare facilities but also ensures high-quality healthcare standards. Healthcare professionals who are sanctioned or excluded from licensure boards can harm these standards. However, when sanctions background checks are employed on every employee, it enables a medical organization to prevent onboarding unreliable professionals and maintain healthcare standards.

Healthcare Frauds Are Prevented

Fraudulent and non-compliance behaviors to regulatory standards get any healthcare professional sanctioned or excluded from the board and such people should remain distant from entering the healthcare system. In 2022, the United States faced 8.4% of all theft and fraudulent cases due to healthcare fraud. If such fraudulent actors are allowed in healthcare without any sanctions checks, they can resume their fraudulent activities harming the financial and integral system of any institution.

Trust in Healthcare System is Upheld

An effective healthcare service can be provided when a patient trusts the institution and the professionals who are reliable and do not allow any fraudulent actor to penetrate the system. This trust can be maintained by staying compliant with sanctions checks and screening out the sanctioned healthcare professionals.

Regulatory Expectations Are Met

Exclusion from healthcare programs such as Medicaid and Medicare is something every medical institute wants to prevent. Apart from that, monetary penalties come as a consequence of onboarding a sanctioned individual in the healthcare system. Compliance with healthcare regulatory bodies such as OIG (Office of Inspector General) and HHS (Department of Health and Human Services) can be ensured by employing effective sanction screening of healthcare professionals before hiring them.

To meet the regulatory demands, it is crucial to understand the regulatory bodies that govern the healthcare standards and their mandate. Let’s dig into it.

Regulatory Mandate & Healthcare Sanctions Check

A standard healthcare system is maintained by globally recognized regulatory bodies while we will briefly shed some light on the four major healthcare governing bodies in the United States that demand healthcare institutions to ensure appropriate due diligence and sanctions compliance before onboarding any medical professional.

The Department of Human and Health Services (HHS)

In America, medical and healthcare services are governed by HHS. It mandates to ensure quality healthcare standards, patients’ well-being and protection, and healthcare policies being implemented.

The Office of Inspector General (OIG)

With a mandate to keep healthcare systems free of any fraud, financial abuses, and compromised standards, OIG plays a strong role in achieving the goals of HHS. The governing body ensures that healthcare programs (Medicare & Medicaid) remain protected from fraudulent healthcare professionals who can potentially harm the integrity of healthcare systems and services.

Centers of Medicare & Medicaid Service (CMS)

Maintaining the healthcare standards, CMS protects the mission of HHS and CHIP (Children’s Health Insurance Program). The agency particularly administers and protects the integrity of healthcare programs and ensures the safety of healthcare beneficiaries and the financial system by endorsing sanctions checks for healthcare professionals.

The Joint Commission

In the United States, more than 20,000 healthcare organizations are certified and audited by the state agency that aims to protect the credibility of healthcare services and professionals. It requires institutions to verify healthcare professionals’ credentials to ensure a safe and compliant healthcare environment thus, indirectly endorsing sanctions background checks.

Having explained the regulatory bodies, one might wonder what if we do not meet these expectations and keep practicing what we have been doing for a long time. The Memorial Health System was one of many that faced non-compliance consequences and let’s take a walk to some other legal and monetary consequences where violations of regulatory mandates put institutions at a loss.

What Happens When Screening Goes Wrong?

The employment of efficient healthcare sanctions checks and continuous monitoring allows healthcare organizations to maintain compliance and health standards. On the other hand, non-compliance brings a handful of legal and financial burdens on institutions.

Disqualification of Federal Healthcare Programs

The healthcare programs of Medicare and Medicaid hold significance for healthcare organizations and violations of regulatory standards can cost exclusion from such programs. Getting barred from such federal programs not only limits the source of funding but also harms the institutional integrity and trust of the healthcare community. To regain financial stability and trust, organizations strive to qualify for the membership of these programs which undoubtedly is a daunting task and impacts the operations.

Governmental Audits and Legal Implications

Healthcare institutions are liable to provide standard care. To ensure the provision of quality services, governmental audits are performed where non-compliance to sanctions or exclusion checks can not be veiled. Leading to several legal and monetary penalties, such audits unwind other unethical or substandard practices in institutions’ operations and open new doors to more unforgiving investigations.

Compromised Medical Practices

An elevated chance of individuals practicing substandard healthcare practices is led by inefficient sanctions checks. Having such professionals on board can cause organizations heightened legal consequences along with increased insurance costs. The entities who get barred because of malpractice in healthcare should not be allowed to resume their practices, which can be ensured through employing functional healthcare sanctions screening.

Elevated Risks of Non-compliance Penalties

Upon compromising the healthcare integrity and patients’ safety, overlooked sanctions screening can lead to hefty fines and sometimes criminal charges depending upon the magnitude of non-compliance or damages to healthcare services. Several health organizations were imposed with heavy fines when oversight sanctions compliance and violated health care program mandates.

Below is a comprehensive set of examples where varying amounts of monetary penalties were imposed on different health organizations as a result of employing excluded or sanctioned individuals.

So far, we have briefly overviewed why your health organization must employ an efficient healthcare sanction check while raising an important concern of how sanctions compliance can be ensured. Let’s try to find the answer together.

3 Real-time Practices of Sanctions Checks

Where compliance has been made imperative to stem healthcare frauds, technology is playing along to make it achievable. An efficient compliance measure is to employ real-time emerging sanctions checks practices where regular and ongoing monitoring allows organizations to prevent fraudulent actors from penetrating the healthcare system.

Due Diligence with Ongoing Monitoring

Subjected individuals can be screened and continuously monitored through exclusion lists issued and updated by state agencies. Continuous insight on such lists enables health organizations to detect any individual who has been barred by the state agency.

These lists are called LEIE (Lists of Excluded Individuals or Entities) and are maintained by the regulatory body OIG. Integrating these lists in sanctions tools allows organizations to keep a robust check on existing and new employees if they get sanctioned or excluded. Compliance requires your organization to never onboard such entities or else face severe consequences as explained before.

Automated Sanctions Checks and Tools

The advancement in technology has facilitated fraudulent actors to dodge the system in so-called ways, it has also empowered organizations who strive to fight against them. Automated sanctions tools, when implemented in a compliance program, enable health firms to automatically get alerted whenever the list updates and any associate gets enlisted.

The tech-integrated tools synchronize the changes in lists and reflect everywhere in compliance software. Placement of such sanctions tools helps organizations to meet CMS compliance demands where federal health programs must be protected from being exploited by individuals who have been excluded.

Supplementary Checks with Periodic Verification

Compliance protocols are majorly met by employing automated sanctions tools embedded with ongoing monitoring. However, periodic verification checks ensure alignment with ever-evolving compliance demands and meet the requirements of internal and external audits.

It also includes verifying the credentials of healthcare professionals against different databases to see if he was not involved in any non-compliance activity before. The compliance mandate of HIPAA (Health Insurance Portability and Accountability Act) also endorses health organizations to keep updated information of professionals which can be obtained through periodic verification.

The integrity of healthcare systems is maintained through compliance that is supported by technology. Just like you, I am eager to explore if meeting compliance needs is easy then why non-compliance occurs so often. Is it shortfalls of technology, lack of accountability, or the inhibited roadblocks in screening processes?

What’s the Future of Healthcare Sanctions Screening?

In an era of unimaginable scientific inventions, predicting an uncertain future is not impossible anymore. Continuously upgrading technology has made it possible to solve man-created problems, human intelligence it is. The evolving trend of regulatory guidelines offers sufficient proof that this chaos is not going away unless a balance of human and artificial intelligence is achieved.

Healthcare sanctions screening is inevitable for the healthcare industry to sustain standards and safety of the sector. AML Watcher aims to make compliance easier yet more efficient for all industries with a pool of huge and diversified datasets. Detecting an excluded individual is not a mystery anymore because a perfect blend of our research and innovation-driven teams ensures the integrity of healthcare and global compliance systems.

Reach out to invest in your compliance future and protect the integrity of the global healthcare system.