What we do
Exclusion Screening, Provider Credentialing Support, and Fraud Prevention with a unique approach that goes beyond compliance.
We have compiled the most comprehensive collection of healthcare exclusions lists in the country. Our primary goal is to assist healthcare providers in meeting their monthly requirement to screen employees and vendors against available exclusions lists. Hospitals and other healthcare providers are required to screen employees and vendors against the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE), the GSA-SAM (System of Awards Management) Exclusion List, and existing Medicaid exclusion lists. If a healthcare provider unknowingly pays a person or entity on an exclusion list, they can face Civil Monetary Penalties adding up to hundreds of thousands of dollars.
Our motto is "Beyond Compliance" -- the minimum to meet the OIG's requirement is to check against three main files: the OIG/LEIE file, the GSA-SAM exclusion list, and state Medicaid exclusions lists. Our compilation of exclusions includes these as well, but we have added 44 State Medical Board Disciplinary Action lists, and our proprietary list of current healthcare fraud indictments, pleadings, and convictions. Our proprietary list is called the Health Care Fraud File (HCFF) and contains manually-harvested data from reliable sources, such as the Department of Justice, the Drug Enforcement Agency, the Office of the Inspector General, the Federal Bureau of Investigations, and more. Our analysts have attached the provider's NPI to each individual (where appropriate), the URL link of the news announcement, and the amount in fraud damages.
Proactive Screening Saves Money: Because our data base has recent indictments, pleadings, and convictions, we are able to identify fraudulent individuals and entities before they make it on exclusions lists. Instead of a pay-and-chase model, where lost dollars have to be recouped, providers can proactively stop fraud leakages and minimize damages.
Timeliness: Other companies search only the LEIE file and other exclusion lists, but the vulnerability with this approach is the time lag it takes for a provider or individual to make it on the exclusion lists. Wouldn't you want to know sooner if you are hiring an individual who pleaded guilty to being pill-mill scheme operator?
Accuracy: Because we have added the NPI to every record in our database and merged all data sources with the NPPES file, we can ensure a high degree of accuracy with a low false positive match rate. Our advanced data matching techniques allow us to search maiden names, nicknames, name and address typos and differences, and phrases captured in different word order.
Flexibility: Our unique compilation of data can be leveraged for other purposes, such as fraud detection or trend analysis. States and Medicaid Fraud Control Units do not always share data across state lines, and by combining all of the Medicaid exclusions lists + recent indictment lists into one, the chances of identifying a fraudulent individual or entity are significantly increased.