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.  We offer monthly or quarterly subscriptions for a reasonable rate, helping a wide variety of clients including provider credentialing service companies, other exclusion list screening organizations, and direct health care providers.

Data Sources

 

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), which includes recent indictments, arrests, and convictions related to health care, harvested from reliable sources such as the OIG, DOJ, FBI, and DEA. 

  • 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.

bduchek@movebeyondcompliance.com

Tel: 800-730-2296

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