We have compiled one of the most recent and effective collection of healthcare exclusions lists in the country. Our primary goal is to make our database available to a wide audience: from hospital staffing managers, provider credentialing firms, to large insurance company Special Investigation Units (SIUs) and fraud detection and loss prevention specialists.
We harvest healthcare fraud data and aim to be the most complete and comprehensive source for healthcare fraud incidents in the U.S.
Many exclusion screening organizations run batch matches against the typical files: the OIG/LEIE file, the SAM (System of Awards Management) file, and state Medicaid exclusion lists. We have gone beyond by manually harvesting state Medical Board disciplinary action lists, recent Department of Justice and other press releases, the OFAC/SDN list, and patient rating data from www.healthgrades.com, and more.
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.