Exclusion Screening

Published
Title: Exclusion Screening Process 
Standard #:

CO – 112

 Issued: 06/05/2015 Reviewed/Revision Date: 04/04/2018

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 Persons” means all USC officers, current USC Healthcare (defined below) employees, contractors, practicing medical staff (credentialed, consulting, residents and fellows), allied health professionals and students of USC Healthcare (including medical, dental, nursing, social work students).
  • “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 42 USC § 1320a-7(a) but has not yet been excluded, debarred, suspended, or otherwise declared ineligible.
  • “Exclusion Lists” include the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE), the System for Award Management (SAM), and all currently available state Medicaid exclusion databases.
  • “USC Healthcare” includes Keck Medical Center of USC, Verdugo Hills Hospital of USC, USC Norris Hospital, USC Care, Keck School of Medicine, USC School of Pharmacy, and the USC Herman Ostrow School of Dentistry.

STANDARD

  1. USC Healthcare shall not knowingly employ, contract with, accept referrals from or use the services of any Ineligible Persons.
  2. USC Healthcare shall ensure that all Screened Persons are screened monthly against the Exclusion Lists.
  3. Students from other institutions who perform a rotation at USC Healthcare may be screened by their home institution.  The home institution must provide a written representation affirming that such institution has screened its own students against the Exclusion Lists and that no student who is performing a rotation at USC Healthcare is an Ineligible Person upon commencement of that rotation.  In addition, USC Healthcare requires the home institution to notify USC Healthcare in writing immediately of any changes in the exclusion status that would render a 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 or to the USC Office of Culture, Ethics and Compliance (OOC), any debarment, exclusion, suspension, or any other event that makes or may make that person or entity an Ineligible Person.
  5. If any unit of USC Healthcare receives notice that a Screened Person has become an Ineligible Person, the individual’s director, manager or other applicable supervisor shall immediately contact the OOC in writing and remove such Screened Person from his/her responsibilities and/or discontinue the use of his/her services.
  6. The OOC 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 USC Healthcare shall appoint a representative(s) (“Representative”) 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 (including Social Work)
    6. Keck School of Medicine
    7. USC School of Pharmacy
    8. h) Herman Ostrow School of Dentistry (including dental students, occupational and physical therapy students)
    9. i) The OOC with respect only to USC Officers as defined by the Office of General Counsel
    10. j) Medical Education Office with respect to all LAC/USC Medical Residents and Fellows rotating thru Keck Medicine of USC
  2. Compiling the List of Names and Information for Submission: The Representative shall compile the list of names and format the list according to the screening organization’s requirements. The list shall include, at minimum, the following fields:
    1. First name
    2. Middle name(s)
    3. Last name
    4. Any previously used or alternative names (including maiden names)
    5. Date of Birth
    6. List all available Professional License Numbers including State License Numbers and NPI number (if applicable)
  3. Submission of the List for Screening: On or before the third (3rd) business day of the month, the Representative shall securely submit the complete list of names and information requested in 2. directly above to the screening organization for processing in the manner and format requested by the screening organization.
  4. Monthly Processing and Receipt of the Report: The screening organization shall run the lists against the Exclusion Lists.  No later than five (5) business days after receipt of the list, the screening organization shall securely provide a report to the applicable Representative of each unit.  Each report shall include the complete results and a time stamp of when the report was run.  If a Representative does not receive a report from the screening organization within five (5) business days of sending the list, the Representative shall contact the screening organization in writing for follow-up and notify the OOC of the delay.
  5. Process for Clearing Screened Individuals: Upon receipt of the report, the Representative shall review and reconcile the results through investigation and, if applicable, provide additional clarifying information to the screening organization within seven (7) business days.  Any identified individual reported on any database requires the Representative to take additional steps to clear the Screened Individual.
    1. Clearing Identified Individuals on Any Federal or State Database: The following information must be utilized to clear a Screened Individual:
      1. Full social security number (this number must be directly entered into the Federal database for a reverse match on every identified individual on a Federal database)
      2. All available license numbers including, but not limited to, NPIs and State Provider numbers
      3. Date of Birth
      4. Addresses (both current and former)
      5. Any provided previously used or alternative names (including maiden names)
      6. Any other information accessible to the Representative including, but not limited to, an individual’s resume, USC background check, social media profiles (LinkedIn, Facebook, Instagram, etc.), Google searches and educational degree information
    2. Inability to Conclusively and Objectively Clear a Screened Individual: If a Representative is unable to conclusively and objectively clear a Screened Individual as per Section 5(a) above, he/she should immediately notify the OOC in writing.  Additionally, the Representative should contact the Screened Individual and obtain a signed attestation form by the Screened Individual on the OOC’s designated form.  Depending on the facts and circumstances, the OOC shall determine if any additional steps are necessary.
    3. After Clearing an Identified Individual: Once an identified individual is conclusively cleared, the Representative must securely email the screening organization the name of the cleared individual and a brief description of how such person was cleared.
  6. Record Retention: The Representative shall document the process used to clear an identified individual from the result report and retain such documentation in an easily accessible format (not solely in one’s email) in accordance with the USC Record Retention Policy located at https://policy.usc.edu/record-management.  Upon request, the Representative must be able to retrieve and provide the documentation to the OOC within forty-eight (48) hours of request.
  7. In all cases of staff turnover or transition, the department administrator is responsible for ensuring that a new Representative is named and trained on the exclusion screening process.

PROCEDURES FOR VENDOR SCREENING

The USC Department of Business Services shall ensure that all USC Healthcare service contractors and vendors are screened against the Exclusion Lists prior to engaging their services and on a monthly basis thereafter. USC Healthcare shall require all vendors to provide a written representation affirming that the vendor will perform a screening of its owners, directors and officers and any of vendor’s employees who provide services for USC Healthcare against the Exclusion Lists on a monthly basis.  Vendor Screening requirements may be modified upon the approval of the Office of General Counsel or the OOC.

All services contracts including, but not limited to, any temporary staffing agreements and applicable USC Templates (including the Services Agreement, Professional Consulting Services Agreement, Independent Contractor Agreement, Professional Services Agreement and Supplemental Staffing Templates),  must contain the following language:  The Contractor shall  (i) upon hire and monthly thereafter screen Contractor and all of its current and prospective owners, legal entities, officers, directors, employees, contractors, subcontractors and agents (“Screened Persons”) against (a) the United States Department of Health and Human Services/Office of Inspector General List of Excluded Individuals and Entities (currently available via the internet at http://www.oig.hhs.gov), (b) the System for Award Management (formally the General Services Administration’s List of Parties Excluded from Federal Programs) (currently available via the internet at https://www.sam.gov/SAM/) and all available State Medicaid databases including, but not limited to, the California Department of Health Care Services’ Medi-Cal Suspended and Ineligible Provider List (currently available at https://files.medi-cal.ca.gov/pubsdoco/sandilanding.asp) (collectively, the “Exclusion Lists”),  to ensure that none of the Screened Persons are currently excluded, debarred, suspended, or otherwise ineligible to participate in Federal or any State healthcare programs or in Federal procurement or non-procurement programs; (ii)  ensure that none of the Screened Persons have any temporary sanction imposed against them by the California Department of Health Services; and (iii) ensure that none of the Screened Persons have been convicted of a criminal offense that falls within the ambit of 42 U.S.C. § 1320a-7(a), but have not yet been excluded, debarred, suspended, or otherwise declared ineligible.

Any Screened Person who falls within one of the above categories is deemed an “Ineligible Person.”  If, at any time during the term of this Agreement any Screened Person becomes an Ineligible Person or is proposed to be an Ineligible Person, Contractor shall immediately notify USC in writing of the same.  Screened Persons shall not include any employee, contractor or agent who is not directly providing services under this Agreement, and who is not otherwise an owner, officer or director of Contractor.  Within twenty-four (24) hours of a request from USC, Contractor shall provide USC with written proof of compliance with this section.

REFERENCES

1. Excel format for employee list

First Name Middle Name(s) or Initial Last Name Date of Birth  Previous Used or Alternative Names (including maiden names) State License Number(s) NPI Number Any Other Professional License Number
Jane J Doe 11/14/1970  Smith; Johnson
John Doe 5/5/1980
Bryan K Jones 8/9/1966

2. Examples of Exclusion Situations

EXAMPLES OF POTENTIAL 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 Culture, Ethics and Compliance at (323) 442-8588 or USC Help & Reporting Line at (213) 740-2500 or (800) 348-7454.