Inasmuch as a sanctioned provider may not submit claims for payment from Medicare or Medicaid, providers who don’t screen against the federal sanction databases run the risk that claims may not only denied but considered false and fraudulent. The EPLS was a separately maintained list that included individuals and entities debarred or suspended from doing business with the federal government, collectively referred to as excluded parties. The OIG mandates that healthcare organizations do not hire or do business with “excluded or sanctioned” individuals or entities.
It can be overwhelming at times to recognize which sources need to be checked for exclusions, and understand how to reference each list.
Implementation of this new system yields a more streamline federal government contracting process. Federal reimbursement, whether direct or indirect, for goods provided or services rendered by an excluded individual or entity, is prohibited. The first phase of SAM.gov includes combining the following systems: If a possible record is found on SAM.gov, you are instructed to go to the government agency directly to verify.
Call (615) 938-7878 today! Similar to operating systems, some federal data sets are easier than others to conduct, search, match, and determine if a possible record can be linked to your employee, vendor, or owner.
While managed care organizations do participate in government financed programs, such as Medicare and Medicaid, it does not make them a government agency. SAM.gov does not have the authority to fine an organization like the HHS OIG does. This list has been in existence since the early 1990’s and is a compilation of those persons and/or entities that have been excluded from participation in federal healthcare programs such as Medicare and Medicaid. The purpose of the SAM exclusion list is no different from the EPLS, which is to provide a list of individuals and entities debarred from contracting with the federal government. h.hj=h.hj||function(){(h.hj.q=h.hj.q||[]).push(arguments)}; As one might imagine, these lists don’t always share information well or have a clear overlap between information necessary to confirm matches and exclusions given limited employee or entity data. To find healthcare exclusions from SAM.gov, you will need to register for access. Unfortunately, the discrepancies between state and federal exclusion data still present a challenge for healthcare professionals looking to identify excluded employees and vendors.
Call (615) 938-7878 today! This category only includes cookies that ensures basic functionalities and security features of the website. While considering the differences in searching and matching in these two divergent databases, it reminds us of choosing between the Android operating system and the Apple iOS system. When it comes to federal exclusion lists, the two sources that need to be screened are the HHS OIG List of Excluded Individuals and Entities (LEIE) and SAM.gov, which now includes the GSA Excluded Parties List System (EPLS). Further, according to Performance Standard 8, all state Medicaid Fraud Control Units (MFCUs), are required to report any actions taken involving terminations and/or exclusions within thirty (30) days of its action to the OIG.
It is important that managed care organization familiarize themselves with the SAM exclusion list in order to maintain compliance with government guidance. Each list is distributed by the individual state.