Healthcare Sanctions Checks: A Complete Guide

healthcare sanctions screening check

As a healthcare organization, you should include healthcare sanctions screenings as a regular part of your pre-employment background check process.

Did you know that two nursing facilities and five employees were arrested for a massive healthcare fraud scheme?

Hiring an individual with healthcare sanctions could place your organization and patients at risk while exposing your company to substantial liability.

At iprospectcheck, we have extensive experience conducting background checks and healthcare sanctions screenings throughout the U.S.

We’ve written this guide for healthcare organizations to use as a resource.

Let’s start now.

What is a Healthcare Sanctions Background Check?

A healthcare sanctions background check searches multiple regulatory and governmental databases to identify people who are prohibited from working in healthcare roles due to past criminal or unethical conduct for which they have been disciplined or convicted.

These types of checks are performed by healthcare organizations under their regulatory requirements.

People might be excluded because of a mandatory administrative sanction from the OIG, another regulatory body, or a state’s Medicaid program.

Agencies impose sanctions on excluded individuals and entities when they have been found to pose an unacceptable level of risk to the program’s integrity and/or patient safety.

Why Are Healthcare Sanctions Screenings Important?

1. Protect Patient Safety.

The primary reason why healthcare sanctions screenings are important is to protect the safety of patients.

Individuals might be sanctioned and barred from working within the healthcare field because of past issues with drug thefts, patient abuse, patient neglect, and certain types of criminal convictions that could threaten the safety of your patients.

2. Protect Your Organization’s Reputation.

By helping you weed out unqualified candidates that should not be employed by your organization, you can avoid potential liability and reputational harm.

3. Maintain Federal Funding Eligibility.

Performing healthcare sanctions checks helps you maintain eligibility to receive funds from federal healthcare programs, including Medicare, Medicaid, and others.

Under U.S. Department of Health and Human Services regulations and guidance from the Office of Inspector General, healthcare organizations that receive funds from federal programs, including Medicare and Medicaid, are prohibited from hiring individuals or entities that have been sanctioned and excluded from participating in those programs except in limited circumstances.

The reasons why someone might be placed on the OIG’s List of Excluded Individuals/Entities include the following:

  • Criminal convictions for Medicaid or Medicare fraud
  • Felony convictions for theft, fraud, or other types of financial misconduct
  • Felony drug convictions for illegally manufacturing, prescribing, distributing, or dispensing controlled substances
  • Patient neglect or abuse

When you perform a healthcare sanctions screening, it will check prospective candidates to ensure they haven’t been excluded from participating in federal healthcare programs.

4. Avoid Stiff Fines.

Under 42 CFR 1003.102(a)(2), your organization can be liable to pay fines of as much as $10,000 for each service provided by a sanctioned individual or each day they worked for your organization.

What Shows Up on a Healthcare Sanctions Check?

A healthcare sanctions check typically includes the following searches:

  • DHHS OIG List of Excluded Individuals/Entities search
  • General Services Administration (GSA) System for Award Management (SAM) search
  • OFAC search
  • State-specific exclusions/debarment lists
  • FACIS check

Here’s what you might see on some of these searches.

OIG LEIE Search

An OIG search checks the LEIE database to determine whether an individual or entity has been excluded by the OIG from participating in federal Medicare or Medicaid programs.

If a candidate appears on the list, you will see that the OIG issued the sanction, the sanction date, whether it remains active, and the nature of the violation if available.

SAM check

A SAM check searches the SAM database to see whether an applicant or entity has been barred from contracting or subcontracting with federal agencies.

If an individual is debarred from engaging in federal contracts and is listed in the SAM database, you should avoid contracting with them if your organization receives federal funds.

OFAC search

An OFAC search checks whether an individual appears on a watch list from the Office of Foreign Asset Control that restricts them from conducting business. This includes terrorism, drug trafficking, and other activities monitored by the U.S. Department of the Treasury.

It also helps to identify individuals from embargoed nations to help organizations avoid fines and penalties for conducting business with them.

Fraud Abuse Control Information System (FACIS) search

A FACIS check also helps identify individuals and entities with healthcare sanctions.

FACIS is a system made up of numerous databases with different levels of data. These databases are regularly updated to help ensure that both your applicants and current employees have not abused patients or engaged in fraud against the government.

You can choose among the following three levels of FACIS searches based on your needs:

  • Level 1 – Searches federal databases from the OIG, DEA, OFAC-SDN, FDA, Medicare Opt-Out, Tricare, and state lists of Medicaid sanctions and debarments
  • Level 2 – Includes additional state-specific information and all of the Level 1 searches
  • Level 3 – Includes all searches from the other two levels with additional information from sanctioning boards in every state and U.S. territory

How Do I Get a Healthcare Sanctions Report?

There are two primary ways healthcare organizations can complete healthcare sanctions screening, including do-it-yourself checks or checks performed by a reliable third-party healthcare background check provider.

Let’s take a look at each of these methods.

1. Do-it-Yourself Health Sanctions Screening

Some healthcare organizations take a do-it-yourself approach to healthcare sanctions screening.

They might check the names of applicants and employees by searching multiple federal and state databases and state licensing boards.

A do-it-yourself approach might not provide complete information or reveal whether an individual has been sanctioned in a different jurisdiction not included in the databases chosen for searching.

Most states maintain individual sanctions databases, making a do-it-yourself search both time-consuming and difficult.

If you attempt a do-it-yourself healthcare sanctions screening, you could end up hiring a sanctioned individual and exposing your organization to substantial liability.

2. Working With a Reliable Background Check Provider

To avoid problems, you should work with a reliable background check provider like iprospectcheck to complete your healthcare sanctions checks.

We have access to all of the relevant federal and state databases and have the resources to quickly complete screenings.

When you work with iprospectcheck, we can also handle all of the other types of searches you need to complete to secure all of the necessary employment background check information needed so that you can make a fully informed hiring decision.

When Should Organizations Conduct Healthcare Sanctions Screening?

Healthcare sanctions checks show whether an individual has been sanctioned by any one of numerous state or federal agencies.

To make these types of checks more effective, you should conduct them several times.

1. Before Hiring a Candidate

Before you hire a candidate to work for your healthcare organization, it is essential to complete a sanctions check.

This helps you to avoid hiring candidates who have been sanctioned.

2. Before a New Hire’s Starting Date

Sanctions lists are periodically updated, so some time could elapse between when an individual is sanctioned and when their name appears on a sanctions list.

This potential time-lapse makes it a good idea to run a second sanctions check before contracting with a candidate or their start date.

3. On a Periodic Basis

You should consider performing periodic healthcare sanctions checks on your existing employees.

Doing so helps to identify whether any of your employees have received sanctions following their date of hire.

How Long Does a Healthcare Sanctions Background Check Take?

How long it might take you to receive a healthcare sanctions background check will depend on whether you attempt to complete it yourself or work with an experienced provider like iprospectcheck.

If you try to check the databases yourself, it could take a long time since there are databases in most states in addition to the many federal databases.

Because of our resources and advanced research technologies, we typically return both healthcare sanctions screenings and full employment background check reports in a few hours.

iprospectcheck: Your Partner for Healthcare Sanctions Screenings and Employment Background Checks

As a healthcare organization, you must check whether your applicants and employees have been sanctioned by federal or state agencies.

Failing to complete healthcare sanctions screenings could expose your company to significant penalties and place your patients and other employees at risk.

At iprospectcheck, we conduct comprehensive healthcare sanctions screenings routinely for healthcare organizations in every state and U.S. territory.

Call us today to request a free quote: 888-509-1979

DISCLAIMER: The resources provided here are for educational purposes only and do not constitute legal advice. Consult your counsel if you have legal questions related to your specific practices and compliance with applicable laws.

Know Before You Hire

About the Author
Matthew J. Rodgers

Matthew J. Rodgers

Matthew J. Rodgers is a highly accomplished business executive with over 30 years of experience providing strategic vision and leadership to companies ranging from the fortune 500 to iprospectcheck, a company which he co-founded over a decade ago. Matthew is a valued consultant who is dedicated to helping companies create and implement efficient, cost effective and compliant employment screening programs. Matt has been a member of the Professional Background Screeners Association since 2009 . When not focused on iprospectcheck, he can be found spending time with his family, fly fishing, or occasionally running the wild rivers of the American west. A lifetime member of American Whitewater, Matt is passionate about protecting and restoring America’s whitewater rivers.