Exclusion Screening

Title: Exclusion Screening Process 
Standard #:

CO – 113

Issued: 06/05/2015 Reviewed/Revision Date:

PURPOSE

To ensure the accurate and timely completion of monthly exclusion screenings against the required government exclusion lists and to establish a review and corrective action process for positive matches.

DEFINITIONS

  • “Screened Person” means all USC trustees, any Governing Board members, officers, directors, current employees, contractors, agents, practicing medical staff (credentialed, consulting or referring), allied health professionals, students, or volunteers of the hospitals.
  • “Ineligible Person” means an individual or entity (a) currently excluded, suspended, debarred, or otherwise ineligible to participate in Federally funded health care programs or in federal procurement or non-procurement programs or (b) that has been convicted of a criminal offense that falls within the ambit of 42 USC § 1320a-7(a) but has not yet been excluded, debarred, suspended, or otherwise declared ineligible.  Ineligible Persons may include nurses, credentialed physicians or allied health practitioners, coders, students, residents, other staff (whether employed, contract or temporary), or vendors.  Examples of some types of Ineligible Persons and prohibited payments are attached.
  • “Exclusion Lists” includes but is not limited to Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE), the System for Award Management (SAM), and all state Medicaid exclusion databases.
  • “Keck Medicine” includes Keck Medical Center of USC, Verdugo Hills Hospital of USC, USC retail pharmacy employees, and USC Herman Ostrow School of Dentistry.

STANDARD

  1. Keck Medicine shall not employ, contract with, accept referrals from or use the services of any Ineligible Persons.
  2. Keck Medicine shall ensure that all Screened Persons are screened monthly against the Exclusion Lists.
  3. Except as otherwise provided in this standard, Keck Medicine may accept a written representation affirming that a school has screened its own students against the Exclusion Lists and that no student who is performing a rotation at Keck Medicine is an Ineligible Person upon commencement of that rotation.  In addition, Keck Medicine requires the school to notify Keck Medicine of any changes in the exclusion status that would render the student an Ineligible Person.
  4. All Screened Persons shall disclose immediately to his or her supervisor, or other individual as designated in the relevant contract, any debarment, exclusion, suspension, or other event that makes that person or entity an Ineligible Person.
  5. If any unit of Keck Medicine receives notice that a Screened Person has become an Ineligible Person, the entity shall immediately contact the Office of Compliance and remove such Screened Person from their responsibilities and/or discontinue the use of their services.
  6. The Office of Compliance shall coordinate with appropriate individuals to develop a corrective action plan to address any regulatory obligations, including refunding payments for the services of Ineligible Persons.  Human Resources, the Office of General Counsel, and other departments may also be consulted about appropriate actions.

PROCEDURE FOR EMPLOYEE SCREENING

  1. The following units of Keck Medicine are responsible for appointing a representative(s) to submit an employee list for the following areas:
    1. USC Keck Hospital/Norris
    2. USC Keck/Norris Medical Staff
    3. USC Verdugo Hills Hospital
    4. USC Verdugo Hills Medical Staff
    5. USC Care Medical Group
    6. Keck School of Medicine
    7. USC School of Pharmacy
    8. Herman Ostrow School of Dentistry (including residents)
    9. Senior Administration as defined by the Office of Compliance
  2. The employee list will be formatted as an Excel file and include the following fields:
    1. First name
    2. Middle name
    3. Last name
    4. Date of Birth
    5. Last 4 digits of Social Security Number
    6. State License Number and NPI number (if applicable)
  3. By the third business day of the month, the employee list shall be sent to the screening organization for processing.
  4. The screening organization will run the employee lists against the Exclusion Lists and then provide a report to the appropriate representative of each unit.  This report will include results and a timestamp for when the report was run.
  5. Upon receipt of the report, the representative shall reconcile the results through investigation and, if applicable, provide additional clarifying information to the contracted reviewer within 7 business days.  The representative will document the process used to clear an identified individual from the result report.
  6. The following information should be used to clear a Screened Individual:
    1. Social Security Number
    2. National Provider Identifier
    3. State License Number
    4. Date of Birth
  7. If a representative cannot clear an identified individual they must immediately contact the Office of Compliance for further evaluation.

PROCEDURES FOR VENDOR SCREENING

  1. The USC Purchasing Department shall ensure that all Keck Medicine vendors are screened against the Exclusion Lists prior to engaging their services and at least on a monthly basis.
  2. Keck Medicine shall require all vendors to provide a written representation affirming that the vendor will perform a screening of its owners, leadership, and/or any other individuals who provide services for Keck Medicine against the Exclusion Lists on a monthly basis.  Keck Medicine will require the vendor to notify Keck Medicine of any such individuals who are on the Exclusion Lists.

PROCEDURES FOR STUDENT SCREENING

  1. Keck Medicine shall either:
    1. Screen all students against the Exclusion Lists prior to engaging commencement of their rotation and monthly thereafter or;
    2. Require a written representation affirming
      1. That the school has screened its own students against the Exclusion Lists, and
      2. That no student performing a rotation at Keck Medicine is an Ineligible Person upon commencement of the rotation.
  2. Keck Medicine will require the school to notify it of any changes in the exclusion status that would render the student an Ineligible Person.

REFERENCES

1. Excel format for employee list

First Name Middle Name or Initial Last Name Date of Birth Last 4 of SSN State License Number(s) NPI Number
Jane J Doe 11/14/1970 5621
John Doe 5/5/1980 4575
Bryan K Jones 8/9/1966 8967

2. Examples of Exclusion Situations

EXAMPLES OF INELIGIBLE PERSONS

  • Transporter who was convicted of patient neglect or abuse related to former employment at a nursing home
  • RN who surrendered her license to avoid charges and now works as a Unit Secretary
  • Respiratory therapist whose license is on probationary status, due to a DUI charge
  • Physical therapist who lost his license due to substance abuse issues
  • Physician who defaulted on an HEAL student loan
  • Biller who was convicted of embezzlement at another employer
  • Patient Care Technician who was convicted of Medicaid fraud due to prior occupation as ambulance driver
  • Technician who prepares sterile surgical trays who previously surrendered her nursing license
  • Payroll clerk who was convicted of misdemeanor drug possession
  • Pharmacist who surrendered his license in one state and moved to another state
  • RN hired by a previous owner of the hospital who since became excluded due to involvement in Medicaid fraud occurring at her second job where she works PRN

EXAMPLES OF PROHIBITED TRANSACTIONS

  • • Payment of salary by hospital to excluded RN who reviews treatment plans
  • • Payment of wages to PRN patient care technician who was excluded for conduct on previous job
  • • Payment of salary to excluded individuals who input prescription information for pharmacy billing
  • • Payment of salary to clerical or billing staff who are excluded due to loss of license or conduct that occurred at previous job
  • • Payment of equipment leasing fees to excluded medical device provider
  • • Payment of medical directorship fees to excluded physician
  • • Payment of fees to nurse staffing agency for provision of contract nurse who is excluded
  • • Filing claim for laboratory services provided pursuant to prescription from excluded physician
  • • Filing claim for radiology services ordered by excluded physician
  • • Filing cost report containing salary costs for excluded transcriptionist

3. List of Citations

Questions regarding policies, procedures or interpretations should be directed to the USC Office of Compliance at (323) 442-8588 or USC Help & Reporting Line at (213) 740-2500 or (800) 348-7454.