Avoid Civil Monetary Penalties - up to $10,000 per violation! Ensure compliance with OIG guidelines today.
What do we do?
OIG Exclusion Screening, Provider Credentialing Support, and Fraud Prevention with a unique approach that goes beyond compliance.
We have compiled the most recent and effective 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 manually-harvested recent healthcare fraud indictments, pleadings, and convictions. Because of the timeliness of our database (it is updated daily), we know that many of the providers, clinics, and individuals are not in any exclusions lists yet. 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, arrests, 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.
Recent. Rich. Reliable.
01 / Recent Arrests
One Day. That is how long it takes an indictment or arrest to end up in our data base. Our proprietary data base is manually harvested daily from the most recent OIG, DOJ, and DEA indictment and arrest announcements. The LEIE file (List of Excluded Individuals and Entities), while still useful, contains old exclusions, and it takes many months for a doctor or individual to end up on the list. Do you want to hire someone or make payments to a provider who has committed a crime but has not made it into an exclusion list yet?
02 / Rich Data
Comprehensive. Health Care Fraud Files combines very recent indictments and arrest records with many exclusion lists, including: the LEIE File, 41 State Medicaid Exclusion Lists, 44 State Medical Board Disciplinary Actions lists, Department of Justice indictments and pleadings, DEA Cases Against Doctors, DEA Indictments and other data harvested from the internet. The data is combined and normalized into searchable pieces of data, with an NPI attached to each record where possible. The data is not limited to health care providers, but other individuals arrested for illegal activity, such as pill mill patient recruiters, medical coders and billing agents, and other individuals you may not want to hire.
03 / Reliable Data
Reliable. All of our manually harvested data contains URL links to the health care criminal news announcements from the most reliable sources: the Department of Justice (DOJ), Drug Enforcement Agency (DEA), Office of the Inspector General (OIG). When you use our Batch Matching services, we will attach the URL Link to your file so you can trace the fraud back to its source.
Who we serve
Beyond Compliance serves a wide range of clients: from small home health care agencies, to large hospital systems, pharmacies, and healthcare insurance companies. Our services support our clients in their compliance and fraud prevention efforts. To learn more, click on the images below.
How it Works
Automated Batch Matching
Our provider, staff, and vendor screening process works as a batch matching solution, whereby you send us your data and we match it against our comprehensive collection of exclusions lists and health care fraud files. We return your data file with a flag indicating the individual or entity was found in our data base, the source and nature of the exclusion or arrest record, the date of the exclusion or criminal activity, and an attached NPI for providers who have one. For all news announcements harvested from the internet, the full URL link is attached, creating a clear audit trail.
Purchase Data Base
Contact us if you are interested in purchasing our data base wholesale. Beyond Compliance has compiled a data base of over 420,000 records of healthcare-related exclusions, suspensions, sanctions, indictments, and convictions. We are always adding more data sources and updating existing lists to ensure our data is recent and accurate.
During the batch matching process, we match against our own proprietary Health Care Fraud File, and the following list of sanctions data bases, which we continually add to to improve the quality of the service we provide. Currently, we screen providers and staff against:
our proprietary Health Care Fraud File (HCFF)
the OIG LEIE File
the System for Award Management (SAM) Exclusion List
the NPPES File (National Plan and Provider Enumeration System) to verify a provider
41 State Medicaid Exclusion Lists
44 State Medical Board Disciplinary Actions (includes suspensions, revocations, voluntary surrendering of license, reprimands, and fines)
Drug Enforcement Agency (DEA) Cases Against Doctors
Advanced Data Matching and Link Analysis
Using advanced data matching techniques, we match names and addresses with a high degree of accuracy, accounting for maiden names, alternate names, typos, and different word order. We have cross-walked specialty code and taxonomy code to assist in identifying the right person, and triangulate client data with the National Plan and Provider Enumeration System (NPPES file) to obtain license numbers, allowing us to match individuals to medical board disciplinary actions lists.
If an excluded or convicted individual is associated with any other health care providers in any way - owner, manager, authorized official, same phone number or address - the individuals and/or entities will be linked together via a common ID assigned during the matching process. This ensures that if you find criminal activity, that you are also aware of any providers linked to that person or clinic. Frequently, an excluded provider will be prohibited from billing from their individual NPI but will become the owner or manager of a clinic under a different NPI to avoid detection. That is why we cross-check names, addresses, phone numbers, and license numbers between individuals and clinics to determine linkages.
To download a sample of our flagship file "the Health Care Fraud File" (nicknamed "HCFF"), click on the button below.
We have 20 years of experience specializing in health care fraud prevention, detection, and complex data management. Our analysts have over 20 years of experience working with healthcare claims data, fraud software development, complex data matching, data link analysis, and Personally Identifiable Information (PII) de-identification.
Our vision is to be the one-stop shop for your compliance and fraud prevention needs. Whether you need to be compliant to check the LEIE File before a hire, or you need to ensure you are not paying someone charged with a recent crime, Health Care Fraud Files will deliver.
Our data matching software combines advanced matching techniques with massive amounts of data, ensuring a high match accuracy rate with minimal false positives. We harness the power of advanced data matching and identity resolution to detect hidden connections in large data bases.