With the Department of Health and Human Services Office of Inspector General (OIG), the Centers for Medicare & Medicaid Services (CMS), and state Medicaid agencies all calling for increased sanction checking, conducting proper sanction screening is essential for any physician.

The problem is that organizations often screen individuals and entities unnecessarily, which can be counter-productive. Regardless of whether the checks are conducted internally or contracted out to a vendor, these excess checks are costly and time-consuming.

This article explains how such unnecessary sanction screenings occur – and how you can avoid them.

Medical Sanctions Check: When Does it Go Wrong?

The most common cause of unnecessary sanction screenings is a lack of clear policy about who is eligible for checks. For example, some organizations check referring physicians who are not on staff and do not have any other established relationship at the hospital.  

In many cases, hospitals will receive referrals from physicians outside the area or who have never referred a patient before. These situations often involve retiree patients who spend much of their time wintering in warmer areas who are referred by a local physician to the patient’s home area hospital.  

Because they are not known to the recipient, there is little identifiable data on file for that physician to confirm a potential “hit.” However, should the check result in a “hit” against the List of Excluded Individuals and Entities (LEIE), payments related to that referral are questioned.

How to Avoid Unnecessary Medical Sanction Screening

The takeaway message is clear: screening referrals from physicians unknown to the hospital is not a good practice. Neither the OIG or CMS require such checking; organizations should avoid them and develop a policy establishing who should and should not be screened.  

Such a policy could state that any and all individuals and entities that contractually provide medical-related products or services shall be screened. This would have the effect of filtering out those that do not meet that criteria and eliminate many of the referring physicians, as well as vendors and contractors that are not relevant to health care. 

Improve Your Sanction Screening Policies with Compliance Resource Center

While the policies we discuss here are a useful way to reduce unnecessary sanction screening, they are by no means the only method you need. Instead, organizations require comprehensive measures to avoid losing money – and Compliance Resource Center can help.  

Our Sanction Screening software grants you fast, easy access to all searchable federal and state databases – ensuring you minimize errors and take timely action. 

Want to learn more? Contact Shelby Cole at [email protected].

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